Associate Director, RN Denials Management
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AI Summary
Department Name:
Denial Recovery-CorpWork Shift:
DayJob Category:
Revenue CycleInnovation and highly trained staff. Banner Health recently earned Great Place To Work® Certification™. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we’re constantly improving to make Banner Health the best place to work and receive care.
As an Associate Director of RN Denials Management, you will be an integral part of leadership within the team. During your typical duties, you will have the opportunity to educate and develop team members, roll out process changes and projects, as well as troubleshooting questions from your team and outside stakeholders.
In this role you will have 10-12 direct reports who will be working centralized denials management for our 31 Banner facilities. A typical day would include overseeing RN denials mgt specialists, posting pre-bill utilization management reviews, conducting calls with payer UR teams, managing workflow and queue designation, and collaborating with our Internal RCM teams to optimize workflows and integrations. This role blends clinical expertise with revenue cycle management to protect the organization's bottom line, decrease A/R and ensure compliance. The team is very independent and works remotely.
Location: Remote, Banner supplies equipment
Schedule: Exempt, Mon-Fri 8am-4:30pm AZ Time (No Weekends or Call)
Ideal Candidate:
Must have at least 5 years' experience as an RN, with current licensure in state of practice;
Must have a working knowledge of medical and third party payer requirements and reimbursement methodologies
Must have a bachelors degree or equivalent experience
At least 1 years of leadership, including Direct Reports
This can be a remote position if you live in the following state(s) only: AL, AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NY, NM, NV, OH, OK, OR PA, SC, TN, TX, UT, VA, WA, WI, WV, WY
Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.POSITION SUMMARY
This position is responsible for providing support to the concurrent and retrospective denials management department for all payers, as well as related audits. This position provides leadership, direction and support in response to denials from federal, state and commercial reimbursement programs. This position is responsible for strategies which will minimize denials to ensure proper reimbursement for services provided by the organization, which includes auditing, managing, monitoring and reporting on trends and suggested education to address specific processes, coding and billing regulations and prevent further claim details. Provides clinical expertise and oversight in the determination of the clinical appeals and denial management process resulting in significant savings for the organization. This position is a resource to the company's RAC team in responding to audit requests and serves to expedite the disposition in claims by reviewing charts and preparing appeals. This position serves as primary educator for staff and physicians in the use of clinical system criteria. Evaluates and intervenes retrospectively for coverage issues, payer outliers, split billing, disallowed charges, incorrect DRG codes, denial and compliance issues. Quantifies, analyzes and monitors industry/Medicare trends in order to reduce denials and improve the financial outcomes for the organization.
Supports change and participates in the development, implementation and evaluation of the goals/objectives and process improvement activities across the organization as related to federal, state and commercial reimbursements.
CORE FUNCTIONS
1. Manages professional or supervisory employees. Hires, trains, conducts performance reviews, and directs the workflow of designated staff.
2. Makes decisions within approved operating plans and objectives and within functional policies and precedents. May manage budget for large and/or complex projects or programs.
3. Sets direction and resolves problems. Resolves increasingly complex customer complaints or problems.
4. Interacts primarily with direct reports, supervisor, customers, peer managers, supervisor’s peers, patients and physicians.
MINIMUM QUALIFICATIONS
Requires a level of education as normally demonstrated by a Bachelor’s degree.
Requires Registered Nurse (R.N.) licensure in the state of practice.
Requires experience in federal, state and commercial reimbursements and in reviewing clinical information typically acquired in three years auditing DRG coding and reimbursements. Requires five or more years of clinical nursing and/or related experience. Experience in hospital operations, reimbursement methods, medical staff relations, and the charging/billing is required. A working knowledge of utilization management and patient services is required. A working knowledge of medical and third party payer requirements and reimbursement methodologies is required. Highly developed human relation and communication skills are required. Must demonstrate critical thinking, problem-solving, effective communication, and time management skills. Must demonstrate ability to work independently as well as effectively with team members. Must have developed leadership skills, interpersonal skills and the ability to work collaboratively in a matrix model as normally demonstrated through three or more years of leadership experience.
PREFERRED QUALIFICATIONS
BSN preferred. Managed Care experience is preferred.
Estimated Pay Range:
$43.77 - $72.95 / hour Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.EEO Statement:
Our organization supports a drug-free work environment.
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