Director Denial Management and Prevention (RN)
New
J
JobgetherHealthcare revenue cycle
Based in United StatesFull-TimeDirector
Salary114,004 - 219,960 USD per year
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Job Details
- Experience
- 5–7 years of revenue cycle experience, including direct experience with appeals and financial clearance.
- Required Skills
- PowerPoint
Requirements
- Hold a Bachelor's degree in Nursing.
- Have 5–7 years of revenue cycle experience, including direct experience with appeals and financial clearance.
- Have leadership experience within healthcare; revenue cycle leadership experience is strongly preferred.
- Maintain an active Registered Nurse (RN) state license and/or compact state licensure.
- Demonstrate strong knowledge of denial management, appeals, reimbursement processes, and healthcare revenue cycle operations.
- Have strong analytical and problem-solving abilities, with accuracy and attention to detail.
- Demonstrate interpersonal and team-building skills and the ability to build productive cross-departmental relationships.
- Communicate effectively in writing and verbally, including presenting to senior leaders and interacting with internal departments and external agencies.
- Use Microsoft Word, PowerPoint, Excel, and email applications; demonstrate advanced Microsoft Excel skills for analysis, reporting, and performance management.
- Operate effectively in a complex healthcare environment, balancing strategic priorities with detailed operational execution.
Responsibilities
- Provide strategic direction and clinical oversight for hospital denial management, prevention, recovery, and appeal outcomes.
- Oversee system-wide denial appeals operations and the performance and accountability of external appeal vendors.
- Partner with clinical resource management and organizational leaders to identify denial mitigation opportunities and reimbursement improvement strategies.
- Develop and implement operational improvements supporting organizational financial and clinical objectives.
- Establish performance goals using industry best practices, internal benchmarks, and denial management trends.
- Develop and maintain analytics, reporting tools, and dashboards for standardized denial summaries and system-wide decision-making.
- Lead denial mitigation initiatives and advise hospital entities on denial trends, root causes, and interventions.
- Partner with Acute Case Management and Managed Care teams to improve processes and address payer-related opportunities and challenges.
- Work with Corporate Compliance and Rates and Reimbursement teams to align operations and policies with applicable governmental and state regulations.
- Manage business partner and vendor relationships, and support technology optimization for operational efficiency and reimbursement performance.
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