Manager Revenue Cycle Denials & Appeals (Commercial Payers) -PFS Account Resolution - Remote
How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
This position is remote - Work From Home
Under the direction of the Director of HB A/R Management, the Manager RC of Denials and Appeals coordinates all assigned HB
Denials and technical appeals department activities including, but not limited to supervising, training, interviewing, hiring,
counseling and terminating employees, as circumstances dictate. The Manager of Denials and Appeals must provide the
dynamic development of strategies for establishing a continuous improvement work environment, open and closed technical
denial accounts are reviewed, corrected, escalated, or closed within the designated payer time frames and are documented
appropriately in the patient accounting system. The role requires extensive data analysis, trending analysis, project
management, and departmental educational capabilities regarding payor and revenue cycle payment related processes.
This role requires a versatile and well developed knowledge of billing, collections, technical denials appeal/correction process,
and understanding of provider/payor escalation requirements. In addition to a strong understanding and capability of common
business technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessment
and analysis of multiple acute care and LTAC facility accounts receivable portfolios. The core role focus of this position is to
ensure that open and closed technical denial accounts are brought final resolution through reimbursement for services and to
mitigate financial losses through solid operational execution, development and conformity to defined Policies and Procedures.
The Manager must possess the ability to develop and document action plans for quick resource deployment and communicate
timely with staff to understand the specific reasons for on going open technical denial trends. The role requires the ability to
effectively and efficiently communicate both orally and in writing to Senior Leadership, multi-task, meet deadlines, enforce
organizational policies and procedures, maintain high staff engagement, ensure staff productivity, appropriate cost controls and
produce effective operational execution. In addition, the Manager will assist with additional Revenue Cycle related tasks and
duties as assigned.
Required Minimum Education:
Bachelor’s degree in business, healthcare, related field or ten years commensurate experience is required.
Required Minimum Experience:
Three (3) to Five (5) years experience hospital healthcare preferred, claims processing management, collections or other
management, or other management role in a healthcare environment.
Required Minimum Skills:
1. Establish a climate to achieve optimal performance levels and maintain a cohesive work team
2. Demonstrate proficiency in reading UB04
3. Demonstrate knowledge and proficiency Payor Appeal submission (technical)
4. Demonstrate knowledge of billing rules and coverage for all major payors
5. Identify where to locate and review state and federal regulations as they relate to all payers
6. Access Major payer(s) specific provider websites for claim investigation, correction and resolution path
7. Identify technical denial trends effecting the revenue cycle and escalate for needed solution
8. Analyze all technical denials effecting the revenue cycle
9. Create and studies revenue reports/Key Performance Indicators and makes recommendations relative to revenue
cycle processes for optimization
10. Follow standard escalation process in established time frames
11. Demonstrate knowledge and proficiency of claims resolution
12. Review staff productivity report on a weekly basis and identify areas of opportunity
13. Post adjustments at time of account review
14. Create/update department policies and procedures
15. Access Major payer(s) specific provider websites for claim investigation, correction and resolution path
16. Work efficiently under pressure and deal effectively with constant change
17. Operate a computer and related applications
18. Apply appropriate supervisory, management and leadership techniques in an operational setting
19. Work independently and take initiative
20. Demonstrate a commitment to continuous learning
21. Willingly accept responsibility and/or delegate responsibility
We’d like to invite you on a career journey like no other! In return for your contributions, we’ll help you make the most of all life’s moments – on and off the job. Wellstar Total Rewards is designed to provide for your total well-being, including: Your Wellness, Your Pay, Your Future, Your Joy. We think it’s pretty simple – we care for our team members and our team members care for the community.
Make a difference in patients’ lives… and your own! Here, it’s more than healthcare – it’s CareerCare!