Director Denials Prevention Management - OSF HealthCare

Expected pay for this position is $56.87 - $75.35/hour. Actual pay will be determined by experience, skills and internal equity.

POSITION SUMMARY:

The Director of Denials Prevention and Management (DPM) is responsible for providing administrative guidance and leading the DPM operations across hospital and professional billing. The Director of DPM provides feedback to The Directors of HIM, Patient Access, QES, Coding, Revenue Integrity, Hospital and Professional Billing, and Executive Revenue Cycle Leadership to ensure that policies and procedures maximize Revenue Cycle efficiencies, net revenue, and gross revenue across the ministry. The Director of DPM acts as an internal consultant and drives process changes throughout the entire system for all aspects of the Revenue Cycle. The Director builds progressive relationships for process improvement and drives change with Clinical Departments, A/R Units, Payer Representatives, and Health System departments that are affiliated with and impact the Revenue Cycle process within the unit. Within the DPM department, the Director oversees the following functions: strategic pricing, payer updates, payment validation strategy, credit management, denial management, and avoidable write-off prevention over the entire ministry.

REQUIRED QUALIFICATIONS:

Education:

• Bachelor’s degree in health administration, business administration, or equivalent field.

Experience:

• Five (5) years of manager level administrative experience in billing management, Coding, Denial Prevention.

Licensure/ Certification:

• Coding, Registered Health Information Administrator or Registered Health Information Technician certification Certified Revenue Cycle Representative required within 12 months of hire.

Other Skills/ Knowledge:

• Excellent interpersonal and communication skills.
• Solid computer skills, including proficiency with Microsoft software.
• Strong analytical and problem-solving skills, with the ability to be detail oriented.
• Demonstrated expertise in cross-departmental hospital and physician billing policies, denial management, and regulatory and accreditation requirements Familiarity with Lean practices, quality improvement initiatives, and work planning procedures Ability to effectively manage team composed of direct and indirect reporting relationships Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, and trust & respect).

PREFERRED QUALIFICATIONS:

Education:

• BSN

Experience: N/A

Licensure/ Certification: N/A

Other Skills/ Knowledge:

• Able to understand and resolve complex payer issues.
• Knowledge of insurance contracts.
• Experience with payer reimbursement methodologies (Commercial and Government) preferred.
• Knowledge of Epic.
• Preferred knowledge of clinical processes.

OSF HealthCare is an Equal Opportunity Employer.