Res-Care, Inc. Louisville , KY 40202
Posted 2 months ago
Our Company
BrightSpring Health Services
Overview
Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as well as Support staff managing all areas of clinical claim pre and post audit, appeals submission, and reporting to Palmetto in response to ADR's/TPE's/RCD processes across the enterprise HH and HO branches for all payor types striving to minimize lost revenue. Conducts analysis on denials and appeals and identifies trends that present process improvement and revenue protection opportunities.
Monitors state and federal regulatory agencies to maintain up-to-date knowledge on changing rules and regulations affecting NCH denial prevention and management practice. Supports the development of standard operating procedures and plans, training, and ensure the denial department provides subject matter expertise around clinical denial management. This position will also support detailed level reporting and analytics, clinical appeals, root cause analysis, and address identified trends in reasons for denials. Work in partnership with HH & HO operations and customers to drive improvement in the quality of services delivered to patients.
Responsibilities
Qualifications
Requires a clinical background, degree in nursing, physical therapy, or occupational therapy from an accredited or approved school. • Two years of experience in health care utilization review or home care.• Two years prior home health or hospice experience required.
Expert written and verbal communication skills• Strong interpersonal skills• Knowledge of the regulatory requirements at the state, federal, and local level• Ability to prioritize tasks and manage multiple projects• Strong analytical and problem-solving skills with attention to details• Ability to utilize a personal computer and other office equipment.• Proficient use of Electronic Medical Record software.• Proficient use of Microsoft Office Suite-Excel, Word, and PowerPoint• Solid ability to learn new technologies and possess the technical aptitude required to understand flow for data through systems as well as system interaction.
About our Line of Business
BrightSpring Health Services is a leading provider of complementary home and community-based pharmacy and health services for complex populations in need of chronic and/or specialized care. Through the company's pharmacy and provider services to seniors and specialty (including behavioral) populations, we provide comprehensive care and clinical services in 50 states to over 360,000 customers, clients and patients daily.
The company's services foster greater patient and family satisfaction, improve outcomes and reduce health care system costs, and are supported by industry-leading quality outcomes. For more information, visit www.brightspringhealth.com. Follow us on Facebook, Twitter and LinkedIn.
Res-Care, Inc.