Denials Mangement Supervisor (Hospital Billing) - Insurance Department

ECU Health; Greenville (NC); Remote; USD 60,000 - 90,000; Full time

Job summary

ECU Health seeks a Denials Management Supervisor for its Insurance Department. This role oversees the analysis and management of denials, ensuring compliance and optimizing revenue cycle processes. Ideal candidates will have significant supervisory experience and a strong background in healthcare reimbursement practices.

Benefits

Great benefits

Qualifications

• 5+ years in hospital revenue cycle management required.
• 2+ years in a supervisory role in a healthcare setting.
• Knowledge of government/non-government payor practices.

Responsibilities

• Analyze, track, and manage denials collaborating across revenue cycle.
• Monitor reports and workloads to ensure timely resolutions.
• Develop processes to reduce preventable denials and implement efficiencies.

Skills

Communication

Analytical skills

Leadership

Knowledge of payer reimbursement methodologies

Education

Associate degree or higher

Bachelor's degree in healthcare administration or related field

Tools

EPIC

Job description

Denials Mangement Supervisor (Hospital Billing) - Insurance Department

Join to apply for the Denials Mangement Supervisor (Hospital Billing) - Insurance Department role at ECU Health

Denials Mangement Supervisor (Hospital Billing) - Insurance Department

Join to apply for the Denials Mangement Supervisor (Hospital Billing) - Insurance Department role at ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children's Hospital serve as the 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 the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary

As the Denials Management Supervisor, you will analyze, track, measure, prevent and manage denials working collaboratively across all areas of revenue cycle management. You will work with the team to research payment policies and review potential underpayments/overpayments on both facility and professional accounts. This role will work with payers directly to ensure reimbursements are aligned with negotiated contracts.

The Denials Management Supervisor will work closely with the Manager/Director to provide staff oversight/assistance. This position ensures timely and thorough appeal of all non-clinical denials. The Denials Management Supervisor ensures accurate and compliant resolution of all government-mandated audits. This individual works with leadership to design and implement procedures and systems to optimize efficiency and minimize the need for manual processing of accounts.

Responsibilities

• Monitors reports and workloads ensuring that denials are addressed timely.
• Works with the Manager, to develop and monitor goals for the denials team.
• Provides guidance and oversight to denials team to ensure the steady reduction of preventable denials contributing to the reductions of account receivable days.
• Contributes to the steady reduction of denials by addressing complex denials timely, as well as identifying root causes and process improvements to prevent future denials.
• Acts as a liaison to various departments to streamline processes.
• Assesses processes, identifies gaps and implements efficient workflows.
• Prepares and analyzes monthly variance reports to present to Revenue Cycle Leadership that identifies trends by payer of payment variances.
• Identify payment errors and work with the payors for reconsideration/reprocessing of claims.
• Prioritizes workload concentrating on priority work which will enhance bottom line results and achievement of the most important objectives.
• Researches, identifies, and follows up on contract underpayments resulting from contract misinterpretation.
• In conjunction with Manager, maintains a collaborative relationship across all revenue cycle management departments.
• Analyzes trends in denials and coordinates with the other revenue cycle management leaders on managing and resolving issues.
• Performs audits to identify opportunities and trends. Audits to include, but not limited to Remittance Advices, write off and adjustments.
• Understands, develops, implements, and analyzes key performance measures for continuous improvement. Identifies specific trends or issues and communicates status and resolution with leadership.
• Maintain continual knowledge of payor policies to assure optimal reimbursement for all services performed within the system, in compliance with government and third-party payor regulations.
• Participate in provider and third-party vendor conference calls regarding billing/reimbursement issues and trends, as well as Contract Interpretation and Joint Operating Committee meetings.
• Recommends procedural and system changes to improve processes, operational quality and efficiency, i.e., job aides, training resources, and workflow; actively participates in process improvement projects.
• Develops and recognizes staff through coaching, planning, training, appraising, and counseling employees.
• Conduct weekly AR team meetings and 1:1 meeting.
  
  

Minimum Requirements

• Required Education/Course(s)/Training:
• Associate degree or higher and/or 5+ years of experience in professional and hospital revenue cycle account receivable management including government payers is required.
• 2+ years in a related lead or supervisory role within professional and hospital centralized healthcare environment.
• 3 years of experience in combined/comprehensive contract variance review/analysis.
• Preferred Education:
• Bachelor's degree in healthcare administration or related field of study
• Graduate of a medical billing program
• Medical coding experience and/or certification
• Skill Set Requirement:
• Demonstrated knowledge of Epic HB and/or PB workflow process, preferred.
• Working knowledge of payer reimbursement methodologies.
• Excellent communication skills, both written and verbal that present clear and concise information to a diverse audience.
• Knowledge of government/non-government payor practices including precertification, filing deadlines, claims processing, coverage issues and other requirements
• Advanced level skills utilizing reporting data packages, including Excel.
• Knowledge of managed care insurance, governmental health programs, HMOs, and their impact on professional, hospital and post hospital care reimbursement.
• Working knowledge of medical terminology.
• Computer, analytical, reporting and organizational skills
• Must have knowledge of medical practice operations.
• Advanced knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding)
• Governmental legal and regulatory provisions related to claims resolution activities.
• Skill in establishing and maintaining effective working relationships with other employees, patients, physicians, insurance organizations, and the public.
• Requires a hands-on leader with the ability to prioritize, plan, and supervise Hospital, and Professional Claims Follow-up Department.
• Performance Expectations:
• Successful achievement of the following:
• Must be able to work independently and efficiently with little supervision.
• Strong customer service and human relations abilities
• Ability to effect collaborative alliances and promote teamwork.
• Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders.
• Ability to use various computer applications is preferred including EPIC.
• Ability to make good judgments in demanding situations
• Ability to react to frequent changes in duties and volume of work.
• Must have a strong desire to teach / transfer knowledge to team members.
• Ability to recognize, evaluate, solve problems, and correct errors.
• Show proficiency in building and maintaining strong internal relationships while motivating and inspiring team members through effective consultative skills.
• Ability to identify and implement process improvements to optimize revenue cycle performance.
  

Other Information

• Remote role ()
• Day shift
• Great benefits
  
  

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management and Manufacturing

• Industries

  Hospitals and Health Care

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