Director Of Denials Management & Prevention

Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit us at https://www.baptistfirst.org.

Summary:

The Director, Denials Management & Prevention shall oversee the centralized operations of denial review appeal, recovery and management of payer contracts. The Director will collaborate with leadership on the planning and strategic initiatives around technical and clinical denials, payer relations, and hospital collaboration while ensuring regulatory compliance. This individual shall develop and maintain an organized and structured process for facilitating appeals and recoveries to ensure denials and underpayments are appealed in a timely manner in accordance with payer and regulatory requirements. The Director will audit, monitor, and trend denials and recoveries, identify performance and areas of opportunities including system, chargemaster, coding, and manual input. This individual will collaborate with key stakeholders identifying, developing, and implementing process improvement opportunities. The Director will partner with leadership to review existing payer contracts, identify potential pitfalls, and contract language barriers based on the review and analysis of current denial trends and underpayments. This individual will collaborate and assist in contract review and negotiations to ensure contract language will promote and enforce positive outcomes and resolution of claims.

Education / Experience: Bachelor's degree in a business or healthcare related field or equivalent education and experience. Minimum of at least 7 years' experience in revenue cycle in a healthcare system. Minimum of 3 years management experience required.

Knowledge, Skills, and Abilities:

• Experience in managing a large volume of accounts while maintaining a high accuracy and positive outcomes.

• Strong knowledge of various types of payer denials, appeals, and underpayment management to ensure denials are appealed and resolved timely.

• Advanced knowledge of CPT, ICD-10 coding and billing, UB and 1500 billing.

• Advanced knowledge of Medicare, Medicaid and third party payment methodologies.

• Advanced knowledge of CMS Medicare regulations.

• Advanced knowledge of reading and understanding managed care contracts and federal and state regulations.

• Maintain professionalism working and collaborating with internal and external partners to promote positive outcomes.

• Intermediate PC experience required with knowledge of Excel and Word applications.

• Excellent verbal and written communication skills.

• Strong critical thinking and analytical skills.

• Self-motivated.

• Demonstrated ability to drive positive results and change management