Supervisor of Denials Managment and Pay Variance Non-Clinical - ECU Health

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

The Denials Management Supervisor, you will analyze, track, measure, prevent and manage denials working collaboratively across all areas of revenue cycle management. 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. Works with leadership to design and implement procedures and systems to optimize efficiency and minimize the need for manual processing of accounts.

Responsibilities

1. Monitors reports and workloads ensuring that denials are addressed timely.

2. Works with the Manager, to develop and monitor goals for the denials team.

3. Provides guidance and oversight to denials team to ensure the steady reduction of preventable denials contributing to the reductions of account receivable days.

4. 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.

5. Acts as a liaison to various departments to streamline processes.

6. Assesses processes, identifies gaps and implements efficient workflows.

7. Prepares and analyzes monthly variance reports to present to Revenue Cycle Leadership that identifies trends by payer of payment variances.

8. Identify payment errors and work with the payors for reconsideration/reprocessing of claims.

9. Prioritizes workload concentrating on priority work which will enhance bottom line results and achievement of the most important objectives.

10. Researches, identifies, and follows up on contract underpayments resulting from contract misinterpretation.

11. In conjunction with Manager, maintains a collaborative relationship across all revenue cycle management departments.

12. Analyzes trends in denials and coordinates with the other revenue cycle management leaders on managing and resolving issues.

13. Performs audits to identify opportunities and trends. Audits to include, but not limited to Remittance Advices, write off and adjustments.

14. Understands, develops, implements, and analyzes key performance measures for continuous improvement. Identifies specific trends or issues and communicates status and resolution with leadership.

15. 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.

16. 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.

17. 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.

18. Develops and recognizes staff through coaching, planning, training, appraising, and counseling employees.

19. Conduct weekly AR team meetings and 1:1 meeting.


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.

Minimum Requirements

Required Education/Course(s)/Training:

Associate degree 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.


Required Certification/Registration: None

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.

Preferred Requirements

Bachelor's degree in healthcare administration or related field of study

Graduate of a medical billing program

Medical coding experience and/or certification

Other Information

There are 5 openings for this role.

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 applicant’s 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.