Revenue Cycle Manager, Denial And Appeal Management

Overview

This position is primarily remote work, but candidate must reside within the state of Utah for this one; as there are a few times per month that in-person is required.

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

This position is responsible for planning, directing and overseeing the operations and fiscal health of a revenue cycle business unit. Responsible for overseeing and leading the work of the Institutions Denial and Appeal Resolution team in accordance with State and Federal requirements. The ideal candidate should possess an in depth understanding of electronic data exchange interfaces, accounts receivable follow up, denial prevention and appeal resolution. This position has no responsibility for providing care to patients.

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Responsibilities

• Exhibits the ability to understand and analyze denied claims to identify trends and root causes.

• Knowledge of billing systems and payer policies to develop and request standard claim edits, creation of custom edits, review workflows and functions in accordance with policies and procedures to continuously employ denial avoidance strategies.

• Leads efforts to systematically identify denial issues and opportunities for effective solutions while collaborating with other departments to improve processes and deliver results.

• Monitoring denial and appeal activities, performance management, and production standards and quality of results. Providing technical assistance to staff in order to initiate billing to all appropriate payer types. Analyzes data for bill presentation based on requirements and reviews claims for quality.

• Has knowledge of Federal, State, and individual insurance regulations related to fiscal operations of Health Services.

• Oversee the preparation and submission of appeal letters and supporting documentation including monitoring of the status and timeliness of appeal submissions and resolution.

• Research, analyze, and recommend billing and denial prevention methodologies and provide input to strategic decisions that affect the functional area of responsibility.

• Accountable for the development, implementation and maintenance of the Epic for Business Denial and Appeal workflows, which includes functions in accordance with internal and external policies and procedures.

• Leads efforts to systematically collect, compile and report operational performance information, designs, implements and manages metrics and indicators to track performance to Payment Integrity program goals and objectives.

• Coordinates with internal teams, payers and providers to generate high reimbursement rates and low level of denials.

• Hiring, training, developing, and communicating with staff.

• Responsible to provide staff feedback on performance, including on-time appraisals and coaching.

• Responsible to deal with conflicts in a proactive manner and to reach resolution in a timely manner.

• Forms positive relationships with staff, peers, and senior leadership to support the mission, vision, values, and performance standards of the organization.

• Actively engages staff with updates and news as well as involving staff in decisions and work teams. Provides feedback and recognition when appropriate.

• Understand electronic data exchange interfaces with respect to monitoring, tracking and problem solving of HIPAA transactions.

Knowledge / Skills / Abilities

• Demonstrated leadership, human relations, and effective communication skills both oral and written.

• Knowledge of hospital business operations and demonstrated strategic planning skills.

• Ability to interact with leadership, department managers and physicians regarding Billing compliance, outcomes, successes and barriers or other related financial issues.

• Commitment to continuous learning and implementation of strategic visions with focus on IT & Operational partnerships.

• Knowledge of budgeting practices, reporting analysis, and forecasting.

• Responsible for management and oversight of vendors.

• Ability to lead, motivate, and effectively communicate with both on-site and remote staff members.

• Ability to analyze large sets of data and perform department analytics in support of strategic decision making.

• Ability to develop tools, processes, accountabilities for all Billing Compliance decisions.

• Understanding and implementation of CMS policies, Code of Federal Regulations and Commercial billing policies.

Qualifications

Qualifications

Required

• Bachelor's degree in a related area of assignment, or equivalency.

• Four years of more progressively responsible management experience.

• Four years of demonstrated Accounts Receivable experience in a health care setting.

Qualifications (Preferred)

Preferred

• Master's degree in a related area, or equivalency.

• Healthcare claims and billing knowledge/experience.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Carrying, Color Determination, Listening, Manual Dexterity, Near Vision, Reaching, Sitting, Speaking, Standing