Denials Manager

American Family Care; Birmingham (AL); Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare provider is seeking a professional with strong denial management skills and a background in healthcare leadership. The role involves examining denial trends, leading initiatives, and overseeing appeals processes. Candidates should have at least 5 years of relevant experience and be willing to travel. This remote position offers flexibility in work environment.

Qualifications

• Minimum 5 years healthcare leadership experience in RCM environments.
• Ability to travel.
• Experience working with denial management processes.

Responsibilities

• Examine denials data to identify trends and initiatives.
• Lead weekly meetings with stakeholders on initiatives.
• Oversee appeals of denied claims ensuring accuracy.

Skills

Denial data analysis

Healthcare leadership

Communication

Attention to detail

Education

BA degree in related field

Job description

Summary

Job Requirements

Examine denials data to identify trends and potential denials initiatives

Monitor identified denials trends and select top initiatives to prioritize

Work with RCM functional leaders to perform account sampling and document observations

Formulate initial hypothesis for root cause and potential resolution steps

Discuss findings with Denial Management team and RCM functional leaders to validate trends in denial root causes

Lead weekly meetings to introduce new initiatives and review status of ongoing initiatives

Assing action items to specific team members/state holders

Follow-up with action item owners between formal meetings

Oversee the process of appealing denied claims, ensuring timely and accurate submissions

Establish a feedback loop with BPO vendor and RCM functional leaders to drive process improvements and minimize errors

Other duties as assigned

BA degree in related field preferred

Minimum 5 years healthcare leadership experience in RCM environments

Ability to travel

Physical Demands/Work Environment (optional)

Office environment. Sitting and keyboarding for extended periods of time. Frequent telephone use. High attention to detail and ability to focus. Moderate noise level.

This is a remote position.