Supervisor, Denial Management - Hospital Billing (HB)

ECU Health Medical Center•Greenville, NC

3d•$65,520 - $95,501•Remote

About The Position

The Denials Management Supervisor analyzes, tracks, measures, prevents, and manages denials in collaboration with teams across revenue cycle management. The role researches payment policies and reviews potential underpayments and overpayments on facility and professional accounts, working directly with payers to ensure reimbursement aligns with negotiated contracts. Working closely with the Manager and Director, the supervisor provides oversight and assistance to staff and ensures timely, thorough appeals of non-clinical denials. The role also supports accurate, compliant resolution of government-mandated audits and works with leadership to design and implement procedures and systems that improve efficiency and reduce manual account processing. This is a remote, full-time, Monday–Friday day-shift role based out of Greenville, North Carolina. The listed pay range is $65,520.00–$95,501.12 per year.

Requirements

Associate degree or higher and/or at least 5 years of experience in professional and hospital revenue cycle accounts receivable management, including government payers.
At least 2 years in a related lead or supervisory role within a professional and hospital centralized healthcare environment.
At least 3 years of combined/comprehensive contract variance review and analysis experience.
Working knowledge of payer reimbursement methodologies.
Excellent written and verbal communication skills, with the ability to present clear, concise information to diverse audiences.
Knowledge of government and non-government payer practices, including precertification, filing deadlines, claims processing, coverage issues, and other requirements.
Advanced skills using reporting data packages, including Excel.
Knowledge of managed care insurance, government health programs, HMOs, and their effects on professional, hospital, and post-hospital care reimbursement.
Working knowledge of medical terminology.
Computer, analytical, reporting, and organizational skills.
Knowledge of medical practice operations.
Advanced knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding.
Knowledge of governmental legal and regulatory provisions related to claims resolution activities.
Ability to establish and maintain effective working relationships with employees, patients, physicians, insurance organizations, and the public.
Ability to prioritize, plan, and supervise hospital and professional claims follow-up work.
Ability to work independently and efficiently with little supervision.
Strong customer service and human relations abilities.
Ability to build collaborative alliances and promote teamwork.
Ability to support high customer satisfaction among employees, patients, visitors, faculty, referring physicians, and external stakeholders.
Ability to make sound judgments in demanding situations and adapt to frequent changes in duties and workload.
Desire and ability to teach and transfer knowledge to team members.
Ability to recognize, evaluate, and solve problems and correct errors.
Ability to build and maintain strong internal relationships and motivate team members through effective consultative skills.
Ability to identify and implement process improvements to optimize revenue cycle performance.

Nice To Haves

Bachelor's degree in healthcare administration or a related field of study.
Graduate of a medical billing program.
Medical coding experience and/or certification.
Demonstrated knowledge of Epic HB and/or PB workflow processes.
Ability to use various computer applications, including EPIC.

Responsibilities

Monitor reports and workloads to ensure denials are addressed promptly.
Work with the Manager to develop and monitor goals for the denials team.
Guide and oversee the denials team to reduce preventable denials and accounts receivable days.
Resolve complex denials, identify root causes, and implement process improvements to prevent future denials.
Act as a liaison with other departments to streamline processes.
Assess processes, identify gaps, and implement efficient workflows.
Prepare and analyze monthly variance reports for Revenue Cycle Leadership, identifying payer payment-variance trends.
Identify payment errors and work with payers to obtain claim reconsideration or reprocessing.
Prioritize work that supports financial results and key objectives.
Research, identify, and follow up on contract underpayments caused by contract misinterpretation.
Maintain collaborative relationships across revenue cycle management departments with the Manager.
Analyze denial trends and coordinate with revenue cycle leaders to manage and resolve issues.
Conduct audits to identify opportunities and trends, including audits of remittance advices, write-offs, and adjustments.
Develop, implement, and analyze key performance measures for continuous improvement; communicate identified trends, issues, status, and resolution to leadership.
Maintain knowledge of payer policies to support optimal reimbursement in compliance with government and third-party payer regulations.
Participate in provider and third-party vendor conference calls about billing, reimbursement issues and trends, contract interpretation, and Joint Operating Committee meetings.
Recommend procedural and system changes and participate in process improvement projects, including development of job aids, training resources, and workflows.
Develop staff through coaching, planning, training, performance appraisal, and counseling.
Conduct weekly accounts receivable team meetings and one-on-one meetings.
Ensure timely and thorough appeals of non-clinical denials and accurate, compliant resolution of government-mandated audits.
Work with leadership to design and implement procedures and systems that improve efficiency and minimize manual account processing.