Manager, Denial Management

About the Role

The Manager is primarily responsible for assuring that clear lines of authority, communications, and delineation of denial duties have been established and assigned with direction from the Director. The Manager will oversee all applicable denial job functions as stated in organizational and departmental policies and procedures. This includes researching, analyzing, resolving, and trending rejections and/or denials specific to the revenue cycle, such as analyzing denial categories and codes, rectifying issues in the denials management system, and ensuring claim adjudication.

The Manager provides educational programs related to non-clinical denial resolution techniques, keeps informed of new federal, state, and third-party regulations, and coordinates testing or production efforts related to denial resolution workflows. The role involves maintaining appropriate files, reports, and statistical data, coordinating re-bills and adjustments, and collaborating with Managed Care Contracting/Underpayment, Medical Records, and billing staff. The Manager demonstrates a consistent standard of excellence through plans and actions.

Responsibilities

• Manage successful recoveries of denied dollars from insurance carriers.
• Identify, research, mitigate, and resolve issues with revenue cycle billing-related systems.
• Work to minimize overtime expenses and maintain budget levels.
• Report denial trends and conduct root cause analysis to prevent future denials related to billing edits.
• Lead and/or participate in performance improvement projects for the revenue cycle.
• Serve as the functional area’s main contact with internal and external auditors.
• Coordinate and distribute workload to staff, provide training, assist with employee orientation, and document meeting minutes and ongoing processes.
• Interview, hire, train, evaluate, and develop subordinate management staff.
• Develop and recognize staff through coaching, planning, training, appraising, and counseling.

Requirements

• Associate degree or higher and/or 10+ years of related work experience (Bachelor’s degree preferred).
• 10+ years of experience in billing, A/R follow-up, denials management, and non-clinical appeal writing.
• 10+ years of leadership experience in a directly related role.
• Proficient in payment review systems, hospital information systems, and coding methodologies.
• Strong quantitative, analytical, and organizational skills.
• Advanced understanding of Explanation of Benefits (EOB).
• Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards.
• Understanding of CMS Memos and Transmittals.
• Familiarity with medical records, professional and facility claims, and the Charge master.
• Ability to utilize and understand computer technology.
• Understanding of all ancillary charges and multi-specialty departmental functions.
• Strong oral and written communication skills.
• Understanding of insurance terms and payment methodologies.
• Ability to work effectively with physicians, administrative staff, and department managers.
• Identify clerical errors, mistakes in interpretation, imprecise records, and inaccurate service code assignment.
• Perform reviews for appropriateness of coding and charging, including business office activities, systems function, and charging methodologies.

Skills

• Strong understanding of the inter-relationships of Revenue Cycle Departments.
• Strong understanding of Patient Financial Information System and Billing System.

Performance Expectations

• Illustrate autonomous, best revenue cycle practices.
• Demonstrate proficiency in the use of all internal automation and software applications.
• Ensure accuracy and consistency through Quality Review results of all audit documentation.
• Manage multiple projects effectively with innovation, creativity, and vision.
• Investigate and document potential for new program and product development.
• Document results of all special project work and provide recommendations for revenue management opportunities.
• Demonstrate creative problem-solving skills through process improvement reporting and/or internal reporting mechanisms.

Pay

$79,664.00 - $116,116.00/year

Schedule

Monday - Friday, full-time day shift: 8:00 a.m. - 5:00 p.m.

Benefits

Great benefits package available.

About the Organization

ECU Health is a mission-driven, 1,708-bed academic health care system serving over 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system comprises 13,000 team members, nine hospitals, and a physician group with over 1,100 academic and community providers practicing in more than 180 primary and specialty clinics. The flagship ECU Health Medical Center (a Level I Trauma Center) and ECU Health Maynard Children’s Hospital serve as primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve health and well-being through patient care, education, and research.

This is a remote role based out of Greenville, NC.