Responsible for assisting in the execution of workflow designed to evaluate, review and appeal denials and underpayments. Reviews work lists to verify they are being managed effectively and work assignments remain current.
Supervises a team of remote Clinical Denial RN’s to include but not limited to; productivity, regulatory compliance, and quality.
Works closely with the Clinical Denial Management Manager to achieve effective functioning of the Denial Management team as a working Supervisor.
Assists in tracking performance, measurement, monitoring, and reporting of denials management and underpayment functions aligned with established management targets/KPIs. Assists in presenting current state performance to leadership, to include identification of process opportunities; identifies critical decisions that need to be made across multiple stakeholders to align performance to management expectations.
Applies methodologies to measure and analyze volume trends, quality, and staff productivity of assigned work areas. Provides timely feedback to staff based on evaluation of results. Prepares and presents meaningful performance appraisals to staff in a timely manner in cooperation and conjunction with the Clinical Denial Manager.
Reviews and resolve accounts assigned via work list daily. Conducts account history research as required, including navigating patient encounters and charts, reviewing the payer website activity, and researching charge and payment histories.
Assists in providing input for the annual budget and assures cost effectiveness of the work unit (staffing matches workload, develops and oversees applicable productivity measurements, reviews and verifies monthly financial/staffing statements)
Demonstrates effective decision making skills by defining the scope of an issue, identifying the stakeholders whose input is needed, creates and weighs alternative solutions and communicating outcomes. Assists in the creation of strategic plans and initiatives that reflect the department leadership plans using creative and innovative tools.
Participates in denials management committees as required and provides updates on denials trends, issues and remediation plans as needed.
Responds to suggestions from internal customers/staff. Creates a cooperative and productive atmosphere by modeling how to work collaboratively across departmental lines.
Maintains an up to date knowledge of department policies and procedures; responsible for external changes made based off future state revisions to processes.
Performs other duties as assigned by management.
What You Will Need:
RN with Bachelor’s Degree in Nursing, Management or related healthcare field.
Minimum of three (3) years’ experience as Registered Nurse (RN) in an acute clinical setting
Minimum two (2) years denials management experience in a revenue cycle department or related area (registration, finance, collections, customer service, utilization review, case management, medical office, or contract management).
One (1) year supervisory or management experience
Current and valid registered nurse (RN) license
Knowledge and Skills Required:
Strong organizational skills
Strong keyboard and 10 key skills
Proficiency in Microsoft Suite applications, specifically Excel, Word and Outlook
Interpersonal skills to promote teamwork throughout the Denials Management team
Ability to multitask and function in a fast-paced environment
Ability to communicate effectively in written and oral form with diverse populations
Have a good understanding of insurance reimbursement related to all payers including but not limited to Government, Medicaid, and Managed Care / Commercial products
Uses discretion when discussing personnel/patient related issues that are confidential in nature
The Denials Management Supervisor directs and manages staff in performing denial and underpayment related activities including customer service, processing insurance claims, expediting billing and payments for insurance claims, performing outgoing calls and correspondence to patients and insurance companies, denials management and appeals for accurate billing, resolving claim adjudication issues and responding to audit requests.
The Supervisor is responsible for the performance of their team and holds each staff member accountable for the performance of assigned day-to-day activities, to include ensuring effective use of computer equipment and materials within departmental budget and quality standards. Monitors staff productivity levels, quality of output, and resolves workplace-related issues in a timely manner to promote a culture of accountability driving towards continuous performance improvement. Serves as a liaison to other revenue cycle teams within AHS as well as external constituents/stakeholders. Participates in enterprise-wide projects, work groups, task forces, councils, and committees. This position may require occasional travel. Adheres to AHS Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.