Employment Type:
Full time
Shift:
Description:
POSITION PURPOSE
Work Remote Position
(Pay Range: $26.8786-$40.3179)
Supervises and coordinates the day-to-day denial team responsible for all post billed denials (inclusive of clinical denials and for ensuring payments are received on denied accounts, determining root causes of denials and preventing denials within the Hospital or Medical Group revenue operations of an assigned Patient Business Services (PBS) location. Motivates staff to achieve the highest levels to meet the organization goals for customer service, operational and financial performance. This position reports directly to the Manager Denials.
ESSENTIAL FUNCTIONS
Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
Provide hands-on supervision and coordination of daily activities and workflows of the denials team handling the receipt, analysis, and appeals of denials received to achieve optimal area performance and colleague productivity goals as part of the revenue cycle process for an assigned PBS location.
Responsible for the oversight of denial management processes to appropriately maximize reimbursements based upon services delivered and to ensure the claims are paid/settled in a timely efficient manner, which includes resolution of complicated claims which have been denied.
Monitors final adjustments on completed denial accounts (either paid or final denied), and reviews documentation in appropriate system(s).
Reviews and tracks trends for the causes for denials and makes recommendations for problem and issue resolutions based upon colleague findings; reports findings to the Manager and Director of Denials and other PBS leadership.
Supervises communication and follow-up processes related to denials and ensures such activities are submitted tracked, trended and reported timely to key stakeholders.
Prepares service level metrics and explanatory summaries for the Manager and Director Denials and other PBS leadership.
Participates in the redesign of denial management processes and systems to improve service, data integrity, and staff productivity/quality to achieve departmental goals and process outcomes.
Identifies and participates in continuous quality improvement initiatives across the denials team and other functional areas to streamline processes.
Identifies and implements solutions to problems and issues affecting denials activities.
Evaluates potential new colleagues and make recommendations for hiring.
Assists with the identification of training needs and coordinates with the department trainer to develop and conduct training programs, which includes on-the-job training.
Assists with establishing performance standards for denial colleagues. Monitors and tracks colleague activities against established performance standards and provides immediate feedback to achieve performance improvement.
Other duties as needed and assigned by the Manager.
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health's Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
MINIMUM QUALIFICATIONS
Must possess a comprehensive knowledge of revenue cycle functions and systems, as normally obtained through an Associate's degree in Business or Healthcare Administration or a related field, and minimum of three (3) years of experience within the area of revenue management, specifically experience with Denials or other functions related to revenue cycle activities or an equivalent combination of education and experience. Experience in a complex multi-entity organization or large complex revenue cycle services preferred.
Exhibits supervisory skills that emphasize team-building and strong leadership with the ability to provide clear oversight and coordination to the department, while also functioning as an individual contributor.
Supervisory or team leader experience preferred.
Strong written and verbal communication skills. Ability to communicate effectively with payors and work with all levels of colleagues to expedite revenue cycle processes while supporting customer service.
Effective critical thinking and problem-solving skills. Ability to analyze data and prepare related reports and summaries.
Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel.
Strong organizational skills supervising direct reporting relationships
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
This position operates in a typical office environment. The area is well lit, temperature controlled and free from hazards.
Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues.
Manual dexterity is needed to operate a keyboard. Hearing is needed for extensive telephone and in person communication.
The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions
Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.
Must possess the ability to comply with Trinity Health policies and procedures.
The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigne d
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
EOE including disability/veteran
