Recovery

Sarasota Memorial Health Care System•Sarasota, FL

4d•Onsite

About The Position

This leader has accountability and oversight, and supervises the daily activities of the Denials, Appeals, and Recovery department. In this role, the leader sets the tone and models positive leadership behavior, while ensuring individual and teamwork tasks, projects, and responsibilities are completed successfully in support of departmental, organizational goals.

Requirements

Bachelor’s degree required. Relevant work experience can substitute on a year-for-year basis for the required degree.
Minimum of ten (10) years of managed care, appeals/denials and/or reimbursement schedules experience, in which, five (5) years are in written appeals.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification by the American Health Information Management Association (AHIMA).

Nice To Haves

Knowledge of Medicare National Coverage Determinations (NCD) and Local Coverage Determination (LCD) protocols for medical necessity/Advanced Beneficiary Notice (ABN).
Demonstrated leadership skills and understanding of group processes, teamwork, and cost center based management.
Demonstrated knowledge of International Classification Determination Tenth Revision (ICD-10), Current Procedural Terminology (CPT), Diagnosis-Related Groups (DRG), Healthcare Common Procedural Coding System (HCPCS), and Revenue codes.
Knowledge of insurance rules and regulations including Medicare, Medicaid, Managed Care and Commercial Insurance.
Familiarity with Florida statutes as they pertain to managed care operations.
Familiarity with managed care contracts and policies/procedures as well as overall operations.
Demonstrated ability in establishing and maintaining effective working relationships.
Demonstrated ability to analyze problems and consistently follow through to solution.
Demonstrated ability to take initiative and exercise independent judgment, decision-making, and problem solving expertise.
Demonstrated effective oral and written communication skills at all levels.

Responsibilities

Supervises the daily activities of the Denials, Appeals, and Recovery department.
Sets the tone and models positive leadership behavior.
Ensures individual and teamwork tasks, projects, and responsibilities are completed successfully in support of departmental, organizational goals.

Benefits

Total Rewards Package
Paid Time Off (start earning PTO on day one of employment)
Tuition Reimbursement
Discounted Medical, Prescription, Dental, Vision Benefit Plans for Full & Part-Time Employees
Flexible Spending Accounts (Health Care and Dependent Care) - Pre-Tax Dollars
Life Insurance
Competitive rates
Bonuses offered
Disability Insurance
Retirement Savings Plan: 403b
Discounted Child Care & Before and After School Program and Summer Camp!
Bereavement Leave
Free Parking
On Campus Dining w/ a 10% discount
Credit Union w/ teller machines on campus
Direct Deposit
Free Wellness Screening
Free confidential counseling services
Employee Discount Programs
Recognition Programs
Referral Programs
Tremendous growth opportunities for hard workers!