Supervisor-Denials & Appeals-ABQ

Presbyterian Healthcare Services

4d•$50,482 - $77,106•Onsite

About The Position

Build your career strategically to maximize reimbursement outcomes. Direct appeal activities in accordance with Presbyterian PFS policies, objectives, and payer agreements and guidelines. Assist the manager with the development, analysis, and implementation of strategies to improve denial overturn rates, reduce overall denial rates, and enhance cash collections. Continuously evaluate processes to identify opportunities for streamlining and automation, maximizing efficiency and effectiveness. Support root cause analysis of issues and collaborate with operations to implement process improvements that reduce denials.

Requirements

One to two years of college-level coursework OR three years of healthcare business office experience in lieu of college education
Minimum of two years of experience in healthcare billing and/or collections required
Proficient knowledge of insurance billing and reimbursement methodologies
Working knowledge of medical terminology, ICD-10, CPT, and HCPCS coding systems
Familiarity with CMS-1500 and UB-04 claim forms
Experience with 837 electronic claims processing and 835 electronic remittance processing
Demonstrated ability to communicate effectively, both verbally and in writing, with customers, providers, and peers
Strong organizational, interpersonal, and time management skills
Ability to work independently and effectively in a fast-paced environment

Responsibilities

Supervise the day-to-day operations of the Denials and Appeals team, ensuring accounts are processed in accordance with established quality and performance standards.
Monitor system-generated reports, quality audits, and work queues to evaluate performance and identify opportunities for improved efficiency and effectiveness.
Develop and implement strategies to improve denial overturn rates, reduce denial volumes, and enhance overall cash collections.
Assist leadership in ensuring all processes are documented in accordance with PHS standards to support regulatory compliance and audit readiness.
Identify, investigate, and resolve complex denial issues, ensuring coordination across Professional Billing (PB) and Hospital Billing (HB) and all impacted stakeholders.
Serve as a subject matter expert and resource for internal and external inquiries, promoting clear, timely, and effective communication.
Review inventory and workload trends daily/weekly to prioritize work, allocate resources, and establish team assignments.
Participate in denial management workgroups and collaborate with cross-functional teams to improve operational processes and reduce denial rates.
Lead team performance, including hiring, coaching, counseling, and disciplinary actions, and partner with leadership to implement corrective action plans when needed.
Foster a high-performing, customer-focused team by promoting continuous learning, reviewing payer policy updates, and ensuring compliance with all regulatory and payer requirements.
Perform other duties as assigned and support Patient Financial Services (PFS) projects as needed.