Manager, Denial Prevention & Process Improvement

Adventist Health•Roseville, CA

35d

About The Position

Serves as a primary contact and facilitator between shared services revenue cycle operations and market operational departments for denials review and prevention coordination. Communicates to patient financial services, market revenue cycle management (MRCM) team, and market operational leadership current and historic denials metric. Provides insights into operational processes which influence initial claim denials and final account write off accounts. Works in coordination with the shared services, MRCM, utilization management, care management, and market operational leadership to develop targeted action plans to prevent claim denials. Provides quality support services to maintain a high level of operational accountability and continue to elevate revenue cycle operations to deliver an exceptional experience. Ensures clear communication and an effective relationship between all revenue cycle and market operational departments.

Requirements

Bachelor's degree in business administration, accounting, finance, information technology, or health administration, or equivalent experience within revenue cycle operations, revenue metrics and analytics, and revenue management, or equivalent combination of education and experience: Required
Five years' of acute and ambulatory experience in a multi-facility, integrated health care delivery system within revenue cycle: Required
Five years' leadership experience in a multi-facility, integrated health care delivery system or consulting experience.

Nice To Haves

Master's Degree
Experience with Cerner, Epic, and/or EHR conversion
One year leadership experience

Responsibilities

Completes denial reason analysis.
Identifies denial trends.
Determines root cause mitigation recommendations.
Monitors integrity of the claims submission process.
Supports recurring denial prevention meetings with all stakeholders.
Participates in interdepartmental resolution strategies.
Maintains data on the types of claims denied and root causes of denials and collaborates with appropriate parties to make recommendations for improvements and resolving issues.
Coordinates and facilitates educational programs for revenue cycle department leaders.
Creates materials and trains denial prevention staff, revenue cycle leaders, and committee members as necessary on denial-related trends.
Develops and implements administrative procedures and review of current processes.
Supports maintenance or third-party payer relationships, including responding to inquiries and coordinating meetings.
Collaborates with patient financial services for escalation priorities and accounts for review.
Ensures alignment with organizational priorities.
Collaborates with MRCM team to ensure cohesive communication to market operational leadership.
Presents to large groups which may include market or senior leadership.
Organizes data in a professional way to communicate with leadership.
Performs other job-related duties as assigned.