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E

Denials Manager (Zero Balance/Underpayments)

enablecomp · 30+ days ago

Franklin, TN

Negotiable

Full-time

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Recognized as a 2024 Top Workplace by the Tennessean, EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims.

Our Mission

We partner with healthcare providers to maximize reimbursement from complex claims payers by having the best people, processes, products and performance.

Our Vision

We enable healthcare providers to do what they do best.

Position Summary

The Denials Manager is responsible for providing leadership and supervision to a Revenue Services team for the purpose of obtaining quantifiable results from and setting priorities for direct reports. Leads a dedicated product/service team to deliver best-in-class results to our clients.

Key Responsibilities

Serve as SME for Commercial and Government contracts and ensure team understands how to apply contract language
Assist team with efficient review of hospital contracts to identify and collect cash payments from Commercial and Government insurance companies, ensuring prompt payments of delayed, denied and underpaid claims.
Ensure the processes and inventory are in place to hit monthly, quarterly, and annual revenue expectations for the company.
Take the lead in explaining variances to management on a regular basis regarding bill filed, appeal filed, and revenue metrics.
Responsible for hiring, staff training and oversight, including annual goal planning, annual reviews, monthly account reviews, job assignments for each staff member with at least weekly monitoring, meet with various staff weekly (based on project due dates) for discussion on project progress, road blocks, assistance on process and provide any tools and input needed. Ability to direct and motivate staff.
Measures and monitors key performance metrics and delivers concise performance reporting to stakeholders with corrective action plans for variances when appropriate.
Assists in setting the strategic direction of the revenue services team and identifies areas of continuous improvement in conjunction with the leadership team.
Assists in preparation and presentation of weekly, monthly, and quarterly client reporting.
Maintain a current working knowledge of all related HIPAA regulations and ensures staff compliance to these requirements. This includes updating work processes, system capabilities, and policies and procedures as well as training staff on these requirements.
Maintain a strong knowledge of insurance billing and reimbursement procedures and regulations related to insurance billing and collections.
Assist in the development and monitoring of quality and productivity metrics and benchmarks for the revenue services functions based on industry standards and internal benchmarks.
Authority to terminate staff as necessary to enable it to achieve the approved strategy.
Management of Revenue Services department.
Ensures smooth operations and improves customer satisfaction.
Assist team with assigned tasks.
Assist in Mentoring Supervisors.
Other duties as required.

Requirements and Qualifications

Bachelor’s Degree or CRCR Certification preferred.
Knowledge of Commercial and Government contracts, specifically underpayment review. Billing expertise is a plus.
Knowledge and understanding of financials, HMO’s, hospital revenue cycle process, ancillary and provider contract language and familiarity with healthcare and provider data sets and trend spotting.
Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
Above average analytical and critical thinking skills.
Full understanding of hospital reimbursement, Intermediate knowledge of Managed Care contracts, Contract Language, and Federal and State requirements.
Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims.
Ability to prioritize work and meet deadlines is required.
5-7 years’ experience in management or supervisory experience with teams of 12+.
5-7 years’ experience in healthcare setting, information technology company or managed care industry, preferably in the area of Finance/Collections, Business Operations or Revenue Recovery.
Experience working with internal teams while serving in a client facing or client support role.
Must communicate effectively and professionally with solid attention to detail and verbal and written problem-solving. Specifically, strong telephone communication skills are required.
Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
Regular and predictable attendance.
Equivalent combination of education and experience will be considered.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations and Prerequisites

Strong and professional written and oral communications skills.
Has worked in a production environment and can meet deadlines. Provide examples of goals measurement for yourself and your team.
Excellent people skills to interface with multiple internal stakeholders.
Proven success in obtaining quantifiable results from and setting priorities for direct reports. Describe how you manage to individual goals.
Organized and can handle multiple projects simultaneously.
Health care experience and familiarity with payers, contracts, and provider data sets.
Experience communicating obstacles & challenges and developing action plans to present to management.

EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.

EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you.

Don’t just take our word for it! Hear what our people are saying:

“I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” – Revenue Specialist

“I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” – Supervisor, Operations

•

Last updated on Oct 3, 2024

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