Manager / Sr Manager - Denial Management

Job Title: Manager Denial Management

Experience and Eligibility Criteria:

• 10+ Years’ experience in Inpatient/Outpatient Coding and denial management.
• Experience with medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB-04).
• Good knowledge in denial scenarios.
• Proficient in Microsoft excel, word, and PPTs.
• Good Knowledge in clinical indicators.
• Good knowledge in Insurance Guidelines.

Behavioral Competencies:

• Accountability.
• Good communication skills.
• Excellent time management and organizational skills.

Job Responsibilities:

• Responsible for assisting with the day-to-day oversight of appeals staff, which include inflow monitoring, work assignment, reviewing employee time records and providing feedback to supervisor/coordinator on employee performance.
• Developing and implementing unit goals and objectives, new and revised programs, work plans, systems, policies, processes, procedures, and methods of operation.
• Assign work activities, projects, and program responsibilities, monitoring workflow, and reviewing and evaluating work products, methods, and procedures.
• Responsible for monitoring work queues, including deployment of the users to areas of greatest need.
• Monitor operations with respect to workflows and regular reporting: evaluate workflows for maximum efficiencies, problem solve work queue issues and making recommendations as necessary. Maintain updated documentation of all workflows.
• Provide analysis and recommend and implement improvements to the appeals and follow up processes.
• Fully engages in real-time performance monitoring to facilitate achievement of service level agreement requirements.
• Creating logics based on denial patterns. Consolidating denials from 837 and Appeals Data and analyze the reasons for denials. Work with Front-End Operations Team and notify if any fall outs and gaps to be filled and come up with logics to prevent denials.
• Develop strategies on quality Improvement by mitigating errors.
• Training new employees.
• Quick response to facility/BO queries to fix issues within timeline.
• Explore the automation opportunities and assess the feasibility of effective implementation.
• Analyze payer-wise denial trends and suggest additions/revisions/deletions to work queues to improve efficiency and reduce denials.
• Identify denial patterns and escalating to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.
• Available to Team Members to clarify queries.
• Data collection, statistical analysis, interpretation and presentation using dashboards
• Participate in meetings with Facility, Billing Office, and work for quick resolution for query accounts.
• Completing projects within timeline