Denial Prevention Director- Remote

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Posted 4 days ago United States Salary undisclosed
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Job Description

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
This is a client facing process improvement position. Liaison between facility and Conifer operations for multiple facilities. Executive resource for Conifer for client local leadership. Focused on growing on-site relationships via client revenue, reputation and image by service, and performance for the client. Critical responsibilities include: (a) engaging key client executive management to understand needs (b) working with Conifer internal business colleagues to assess, develop, and recommend denial service solutions; (c) educating the client, monitor denial performance objectives, prepare for and conduct monthly denial meetings, (d) report with peer-level operations personnel underlying metrics, and improvement opportunities to ensure it meets/exceeds the expected levels of performance, (e) ensuring the contractual expectations are met and exceeded, (f) setting strategy that continues to long-term strategy of overall client account.
Include the following. Others may be assigned.
  • Oversight Management ' be conversant in the underlying denial operations and client environmental and placement metrics that drive the ebbs and flows in revenue, and affect positive movement in each on a peer-level dotted line relationship with strategy and operations.
  • Client Management -- Serve as primary on site contact for Denials Management and other key sponsors, present a knowledgeable, efficient, and professional image by handling business in a respectful and professional demeanor, and excel in the following activities:
    • Client Advisor ' Rise to the level of trusted advisor to Clients, with respect to Client's own performance.
    • Reporting and Analytics' Prepare and present to client performance reporting, as contracted and appropriate
    • Relationship Management -- Facilitate and maintain relationships through regular, pro-active communication, timely follow-through on requests and coordination of resources to meet client needs
    • Market based collaboration or prevention of denial contribution within accounts recievables. Function as leader of denial subcommittees to reduce failure rates from physician orders, financial clearance, admissions, clinical care management, documentation, discharge planning and appropriate revenue recognition.
  • Company Policy. Adheres to all company policies and procedures including, but not limited to those identified within the Standards of Business Conduct and the Employee Handbook, as may be amended from time to time. Adheres to all applicable laws and regulations and the company's governance/compliance program. Responsible for reporting violations of the company's policies and procedures, Standards of Business Conduct, Compliance, governance program, laws and regulations through the company's Help Line or other mechanism that may be available at the time of the violation. Assists with internal control failure remediation efforts.
    • Internal Controls and Training. Becomes knowledgeable of internal control responsibilities through training and instruction. Responsible and accountable for internal control performance within their area of responsibility. Participates in the internal controls self-assessment process. Ensures concerns with internal control design or performance and process changes that impact internal control execution are communicated to management.
This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Direct Reports (incl. titles) Varies by client site
No. Indirect Reports (incl. titles) Varies by client site
Matrix Reporting Varies by client site

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Requires an understanding of systems and processes that impact revenue cycle performance and capabilities.
  • Possesses the ability to build trusting relationships with Client Executives at all levels.
  • Possesses analytical ability sufficient to work in a data-heavy environment and to identify trends in the data.
  • Possess business acumen with an emphasis on: effective communication (i.e., listening, written and verbal), negotiation, influencing decision makers, business planning, strategy, problem solving, decision making and time management skills.
  • Intermediate MS Office required (Outlook, Excel, Word, and PowerPoint).
Include minimum education, technical training, and/or experience required to perform the job.
  • Demonstrated experience of the entire acute care hospital revenue cycle processes is required;
  • Successful experience leading in matrixed environment.
  • Understanding of the market, trends, competition, and key pain points for hospital executives.
  • Proven success in project management roles to include developing and implementing business initiatives, change management, and bringing together disparate team members to successfully deliver client solutions
  • Bachelor's Degree preferred.
  • Three to Five years Supervisory in a Revenue Cycle or Acute Health Care.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Must be able to work in sitting position, use computer and answer telephone
  • Ability to travel (most driving within Division)
    • 50% Travel
  • Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Office Work Environment
  • Hospital Work Environment
Job: Managers and Directors
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days