Mgr Denials Management
Core
Manages the review of denied claims, coordinates appeals and payer audit processes, and develops policies to prevent denials for Lifespan affiliates.
Role type
Manager of Denials Management
Builds
Denial appeal processes and denial prevention strategies
Domain
Healthcare administration / Medical billing and reimbursement
Deliverable
client delivery
Required skills
Statistical analysis, Financial reporting, Medicare/Medicaid denial appeals, Third-party contract management, Clinical documentation review, Policy development, Staff recruitment and evaluation, Budget development
Preferred skills
Billing and coding certification, Knowledge of NCQA guidelines
Technologies
PC-based systems, Microsoft Teams
Responsibilities
Plan and manage effective review and response to appeals within time limits; Collaborate with Medical Directors to apply uniform utilization standards; Track status and progress of denials and appeals; Conduct research on best practices and policy reforms; Create internal and external correspondence following regulations; Maintain data on denied claims and root causes; Develop and implement administrative procedures to enhance coding activities; Provide clinical support and serve as a resource for coding information; Coordinate education programs for medical staff on denial prevention; Recruit, select, orient, and evaluate denial appeals staff; Provide input into budget development.
Seniority
Manager, supervisory role