Revenue Integrity: Denials & Appeals Manager

Howard University Hospital; Washington (District of Columbia); Sur place; USD 86 000 - 96 000; Plein temps

Avantages offerts par ce poste

Competitive compensation

Comprehensive medical, dental, and vis

Retirement savings plan

Paid time off and holiday pay

Tuition reimbursement and professional

Employee wellness programs

Supportive and mission-driven team

Résumé du poste

Howard University Hospital, a nationally recognized academic medical center in Washington, DC, seeks an experienced Denial & Appeals Manager to lead denial prevention, appeals management, and revenue integrity initiatives.

The role coordinates denial and reimbursement activities, oversees utilization review, and partners with clinical, financial, and operational teams to optimize reimbursement and reduce revenue loss.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Minimum of five (5) years of healthcare, hospital revenue cycle, claims processing, reimbursement, collections, utilization review, or related management experience.
• Previous leadership or supervisory experience preferred.
• Strong knowledge of revenue cycle operations, denial management, appeals processes, and payer requirements.
• Experience working in a hospital or acute care healthcare environment.

Responsabilités

• Lead the denials and appeals process for inpatient and outpatient accounts, ensuring timely review, documentation, and follow-up.
• Coordinate resolution of escalated billing, reimbursement, and denial-related issues.
• Review clinical documentation and supporting records to facilitate successful appeal outcomes.
• Maintain accurate records related to authorization activity, utilization review, denial management, and appeal outcomes.
• Monitor insurance and authorization activity and maintain required tracking logs and reporting.
• Collaborate with physicians, clinical leadership, case management, patient access, coding, billing, and revenue cycle teams to address reimbursement challenges.
• Conduct research, audits, reviews, and assessments related to compliance, reimbursement integrity, and operational performance.
• Support internal audit, risk management, and regulatory compliance initiatives.
• Respond to inquiries regarding account status and reimbursement matters within established timelines.
• Train, mentor, and support staff involved in denial management and reimbursement integrity activities.
• Prepare and distribute reports related to denial trends, utilization review activities, and operational performance.
• Identify process improvement opportunities that enhance reimbursement outcomes and revenue cycle performance.

Connaissances

Denial management

Revenue cycle

Leadership

Payer requirements

Healthcare knowledge

Formation

Bachelor's degree

Description du poste

Howard University Hospital, a nationally recognized academic medical center in Washington, DC, seeks an experienced Denial & Appeals Manager to lead denial prevention, appeals management, and revenue integrity initiatives.

The role coordinates denial and reimbursement activities, oversees utilization review, and partners with clinical, financial, and operational teams to optimize reimbursement and reduce revenue loss.