Mgr Denials Management

remotepromsp; India; On-site; INR 900,000 - 1,500,000; Full time

Job summary

remotepromsp in India seeks a Manager of Denial Appeals to lead review and response to denied claims and to oversee payer audit processes across affiliates. You will drive education on documentation improvement, collaborate with medical leadership, maintain payer relationships, and ensure timely appeals while monitoring denials and implementing improvements.

Remote work is supported under company policy. The role requires developing reports, training staff, and guiding strategic denial

Responsibilities

• In collaboration with the Director, plans, implements and manages effective and efficient review and response to appeals.
• Ensures appeals are filed within time limits.
• Develops policies and procedures and ensures implementation.
• Collaborates with Medical Director and Physician Advisors to apply uniform utilization standards.
• Collaborates with Contracting Department to ensure fair, consistent reimbursement.
• Collaborates with case management and clinical documentation to support level of care.
• Tracks denials and appeals across affiliates.
• Performs research to aid the appeals process and stay updated on best practices.
• Creates correspondence accurately, concisely and professionally while following regulations.
• Maintains data on denial types and causes, and works on improvements.
• Develops and implements administrative procedures to enhance coding activities related to denials.
• Reviews reports from medical records and other departments to inform denial appeals.
• Provides clinical support to Denials and Clinical Appeals staff and other departments.
• Acts as a resource for clinical and coding information across departments.
• Coordinates education programs for medical staff on denial prevention and appeal processes.
• Educates departments on Local Medical Review Policies and National Coverage Determination guidelines.
• Trains physicians and staff on related issues as needed.
• Recruits, selects, orients, evaluates and takes corrective action within the team.
• Contributes to budget development and invites ongoing professional development.

Job description

SUMMARY

The Manager of Denial appeals reports to the Director of Claims reputed company/Follow up. Under general direction and reputed company reputed company policies and procedures, manages and coordinates the review of denied claims and carries out the appeals and payer audit process for the various reputed company affiliates. Assists and participates in the review and development of reputed company reputed company of appeals. Develops and maintains reputed company and accurate statistical data as it pertains to denied cases. Identifies and provides education on areas of documentation improvement with respect to level of care. Works to maintain reputed company-party payer relationships, including responding to inquiries and other correspondence and possibly setting up arbitration between parties. Maintains and monitors reputed company of the claim development and submission process as it relates to denial prevention.reputed company employees are expected to successfully role model the organizations values of Compassion, Accountability, Respect and reputed company, as these values guide our everyday actions with patients, customers and one another.

RESPONSIBILITIES

• In collaboration with the Director, plans, implements and manages effective and efficient review and response to appeals.
• Ensures reputed company appeals are filed reputed company the time limits.
• Develops reputed company policies and procedures and ensures implementation and adherence to same.
• Collaborates with Medical Director and Physician Advisors to apply uniform utilization standards.
• Collaborates with Contracting Department to reputed company fair, consistent and reputed company reimbursement.
• Collaborates with the case management department and clinical documentation department on documentation that supports the level of care, severity of illness and risk of mortality.
• Systematically tracks the status and reputed company of denials and appeals for the reputed company affiliates.
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms.
• Creates reputed company correspondence accurately, reputed company, concisely and professionally while following organizational, federal and state regulations.
• Maintains data on the types of claims denied and reputed company causes of denials, and collaborates with appropriate parties to reputed company recommendations for improvements and resolving issues
• Develops and implements administrative procedures and review of reputed company processes to enhance coding activities reputed company to denials.
• Receives, reviews, and monitors reputed company reports from medical records, ancillary and other departments (using provider liable reports, medical necessity and ABN reports, un-coded accounts receivable reports, etc) reputed company to denials appeals and takes the necessary steps to implement positive change.
• Provides clinical support to reputed company members of the Denials and Clinical Appeals staff as reputed company as other departments.
• Serves as a resource for clinical and coding information for many departments throughout the system.
• Reviews medical record information as needed.
• Coordinates and facilitates education programs for medical staff, department heads, managers and their staff with regards to denial prevention and reputed company appeal process.
• Works with departments involved to ensure understanding of Local Medical Review Policies and National Coverage Determination guidelines and the use of Advance Beneficiary Notices.
• Provides training and education to departments, physicians and their staff as needed regarding these issues.
• Recruits, selects, orients, evaluates and as necessary provides corrective action up to and including termination of denial appeals staff.
• Provides input into development of budget to meet anticipated needs.
• Maintains and enhances professional self-development by participating in appropriate workshops, conferences, and/or in-services.
• reputed company other reputed company duties as required.

WORK LOCATIONS/EXPECTIONS

• After orientation at the Corporate facilities, work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote reputed company Policy and Procedure.
• Full time schedule worked in office
• Full time schedule worked in a dedicated reputed company in the home
• Part time schedule in office and in a dedicated reputed company reputed company the home
• Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish reputed company job functions reputed company the said schedule.
• Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours.
• Staff must be signed into reputed company Teams during their entire shift and communicate with Supervisor as directed.

PERFORMANCE