Manager, Denial Management

Hackensack Meridian Health•Edison, NJ

1d•Onsite

About The Position

The Manager, Denial Management, is responsible for the daily operations, financial oversight, and efficient performance of the Managed Care department. This role emphasizes managing accounts sent, ensuring corrections are applied, and reducing accounts received through proactive oversight. This position directly oversees denial processes, serves as the subject matter expert in Contract Management, and leads initiatives to prevent denials while improving account management efficiency. Additionally, develops and monitors reporting and benchmarks across hospitals and the network, ensuring alignment with efficiency metrics and organizational performance goals.

Requirements

Bachelor's degree in finance related area of concentration or business administration with concentration in finance or management.
Minimum of 4 or more years of experience in Healthcare/Billing/Collections/Managed Care/Revenue Cycle.
Minimum of 2 or more years in managerial role.
Proficiency with Windows applications, particularly in Excel, as well as Hospital Billing systems, SMS and EPIC.
Strong report writing skills, outcome driven and technology savvy.
Strong knowledge of healthcare industry revenue integrity key performance indicators and best practices.
Change agent, capable of guiding teams in initiating change management initiatives with a view of leading and guiding towards the future, but respectful of organizational history and culture.
Strong multi-tasking skills and the ability to work at multiple facilities.
Ability to gather complex data, compile usable information and prepare reports that are understandable by members of the organization.
Excellent written and verbal communication skills.
Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.

Nice To Haves

Resolute Hospital Billing.
Reporting Workbench.

Responsibilities

Manages Denial Dashboard for the HMH Network with Primary oversight for strategic decision making for all automation of process. Achieved through: a. Investigation and resolution of problems to ensure coordinated efforts; works closely with the Revenue Cycle Department to mitigate AR aging & Denials. b. Building strong working relationships with applicable parties within HMH and external vendors. c. Manage the Medical & Technical Denials (where appropriate) denials - work closely with Case Management, Utilization Review, Physician Advisors, Registration/Access & other departments that have impact on Denials. d. Identify variables in getting full payments & recommend solutions to accelerate revenue. Denials are analyzed, posted, and routed to the appropriate areas. e. Manage all Dashboards related to Denial Management
Perform duties which guide the management of the under/over payments, adjustment and denial posting and processing of credit balances functions of the business offices for the HMH Network. a. Ensures that Denial work queues (WQ) are maintained to ensure smooth flow of accounts based on the needs of the department. b. Ensure that accounts are denied correctly based on Contract Management as this is crucial in preventing accounts aging or denying incorrectly. c. Building of strong working relationships with IT (Information technology) to expedite resolution pertaining to Contracts. d. Current payer trends, rules and regulations by Medicare, Medicaid and Commercial Payers. e. Establish a regular meeting with the pay representative to resolve and/or escalate payment variance.
Collaboration with the corporate finance team to ensure understanding of revenue cycle transactions as well as proper revenue cycle financial reporting.
Develops, revises, publishes, and monitors reports to support the Denial team. Includes, but is not limited to medical denials, technical denials and Bad Debt reports. Where necessary, implement corrective action plans.
Maintains and supports a cross-functional matrix with internal and external customers for Population Health, including but not limited to Case Management, Finance, and Patient Financial Services teams.Disseminates and communicates policy changes and guidelines from the payers.
Works collaboratively with Revenue Cycle Training Manager to design, develop and administer educational training programs.
Develops and implements quality assurance measurements and standards, including completion of internal and external audits. Responsible for yearly external audit by PWC (or other entity engaged to conduct the yearly audit) as it relates to Revenue Operations-related questions. Respond to payer audit requests.
Audit manual adjustment performed by Revenue Operations staff to determine if there is an issue that needs to be addressed. Perform staff audit to ensure allowance or balance are being done correctly and the team is in compliance with the set guidelines of processing debit or credit variance Develops, revises, publishes, and monitors reports to support the Denial team. Includes, but is not limited to medical denials, technical denials and audit reports. Where necessary, implement corrective action plans. Maintains strong relations with the Case management team.
Disseminates and communicates policy changes and guidelines from the payers.
Develops and implements quality assurance measurements and standards, including completion of internal and external audits. Responsible for yearly external audit by PWC (or other entity engaged to conduct the yearly audit) as it relates Managed Care-related questions. Respond to payer audit requests.
Audit manual adjustment performed by revenue operations staff to determine if there is an issue that needs to be addressed. Perform staff audit to ensure allowance or balance are being done correctly and the team is in compliance with the set guidelines for processing debit or credit variance.
Collaborate with the Training department if process changes must be developed based from discovery, new technology, change in payer rules or change in internal processes. a. Handles the development of reporting tools for management utilizing the current information system and/or identifying other software programs to achieve desired reporting outcomes. b. Requests, obtains, and distributes monitoring reports (ad hoc), Reporting Workbench, Radar, BI reports to the appropriate leaders and supervisor the ultimate delegation to review and subsequent staff assignment. c. Performs data mining and in-depth analysis of root cause of payment variance or denial.
Recruits and selects talent and manages staff in the HMH Network. Formally evaluates performance and professional development of staff. Performing disciplinary actions where necessary. Other duties and/or projects as assigned.
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.