Position Highlights:

• The position will act as a Supervisor for the Denials and Collections team. Responsible for the coordination and management of the denial review and appeals process for the managed care payers. Ensures the team performs timely claim follow-up and resolves denied claims appropriately. Identifies opportunities with the denied and aged claims with a focus on process improvement and maximizing revenue. The Denials Team Supervisor will ensure that all key performance indicators (KPI's), productivity, and quality metrics are measured and met by the team.

The Ideal Candidate:

• The ideal candidate will have supervisory experience working with medical claims in a hospital, physician, payer or third party medical billing service setting.
• The candidate will also have experience with collections within a hospital or physician setting

Responsibilities:

• Ensure all new hire staff and existing staff have the necessary training required to complete all their assigned tasks. Provide coaching to promote team member growth. Develop and complete quality reviews for direct reports. Able to provide detailed feedback to team members and ensure that directives are comprehensive and well written. Maintain confidentiality at all times.
• Maintain and ensure all Team members follow department policies and procedures. Establish workflow efficiencies within the Denials and Collections Team. Create and update Policies and Procedures and Operational Guidelines for team.
• Recruits, hires, and supervises staff. Assesses and conducts staff evaluations, annual performance evaluations, administers disciplinary action. Leads all day to day functions of the Denials Team.
• Ensures denials and aged accounts are worked timely and efficiently by the team. Conducts a detailed review of account volume as directed by Manager. Identify opportunities for process improvement for denial volume and denial prevention
• Works with the Denials and Collections Team to identify the root cause of denials and trends by Payer in order identify opportunities to avoid denials or delay of payments. Able to share examples to Coding, Billing, and AR Team.
• Identification of coding, billing, or reimbursement errors/discrepancies with the denial or aging claim in order to escalate to the Managed Care Department and/or Provider Reps
• Team development and/or Individual Team member coaching

Credentials and Experience:

• Bachelor’s Degree required – field of study: Healthcare, Finance, or related field
• Minimum of three (3) years in a supervisory or lead role.
• Minimum of six (6) years experience working with medical claims in a hospital, physician, payer or third party medical billing service setting with collection experience is required.
•  Additionally, a minimum of three (3) years of Physician denials experience.

* -OR- Associate’s degree with an additional two (2) years of relevant claims/collection experience plus the six (6) years (for a total of 8 years) experience may be considered "in lieu" of a Bachelor’s degree. Additionally, a minimum of four (4) years of Physician denials experience.

 * -OR- High School Diploma with an additional four (4) years of relevant claims/collection experience plus the six (6) years (for a total of 10 years) experience may be considered "in lieu" of a Bachelor’s degree. Additionally, a minimum of five (5) years of Physician denials experience.