The Denial Mitigation Manager manages the daily operations of the Denials Mitigation team to ensure that appeals and correspondence are processed in a timely manner and in accordance with BMHCC and/or the payer's policies and procedures. The manager has a thorough understanding of Baptist's Revenue and Reimbursement Cycle, payer contractual guidelines, billing procedures, including the billing software system.The manager will be responsible for analyzing and interpreting trends associated with inventory, correspondence, audits and appeals to effectively manage reimbursement, and build strategies for mitigating future denials. This role will develop training and tools to support the denials and appeals management processes to include functioning as a working manager.The manager has a clear and functional understanding and the ability to troubleshoot the roles supported.Responsible for assuring compliance with all local, state and federal regulations.Incumbent is accountable for these functions 24 hours per day, 7 days per week.This position is under the general direction of the System Manager, Denial MitigationResponsibilities
1.Responsible for overall operational supervision of the Denial Mitigation Department as it relates to outpatient work and total inventory.
2.Responsible for write offs, timely filing, and quality audits and reviews as well as work queue oversight, and delegation of assignments in those areas as applicable.
3.Responsible for trending inventory and reporting for all areas of oversight.
4.Oversees all activities related to DMU outpatient side of work as well as oversight of coordination, processing and appeals for medical claim recoupments due to clinical audits.
5.Oversees day-to-day supervision of all direct reporting staff to include training, work queues, monitoring of compliance and quality, establishing individual and team performance measures, recruiting, hiring/terminating, timekeeping, conducting performance reviews, and establishing goals.
6.Collaborates with the Manager/Director/Revenue Cycle Team in the resolution of treatment and services recouped by Medicare, Medicaid, Tricare, commercial payers, and Managed Care organizations.
7.Recommends and implements departmental policies, procedures, and methods to increase the overall effectiveness of the denial management program.
8.Coordinates processes for collecting, organizing, analyzing and reporting data to enable leadership and others to make appropriate decisions to improve the denial mitigation process.
9.Works with internal and external customers to identify opportunities for improvement, and participates in subcommittees (e.g. Medical Necessity, Correspondence, DRG) which result in enhanced denial management services and customer satisfaction.
10.Performs other duties as assigned and directed.
11.Contributes to a positive work climate and the overall team effort of the department.Requirements, Preferences and Experience
High School Diploma required, Associates or Bachelor's Degree in related field preferred
3-5 Years Revenue Cycle, Denial Management, ROI, or HIM Experience preferred
Extensive understanding of Revenue Cycle functions, flow, and operations requiredInterpersonal Requirements:
Must be self-starting and able to work with limited direct supervision. Must be able to effectively and efficiently communicate verbally and in writing. Must be able to supervise employees.About Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.At Baptist, We Offer:
- Competitive salaries
- Paid vacation/time off
- Continuing education opportunities
- Generous retirement plan
- Health insurance, including dental and vision
- Sick leave
- Service awards
- Free parking
- Short-term disability
- Life insurance
- Health care and dependent care spending accounts
- Education assistance/continuing education
- Employee referral program
Position: 17586 - Manager- Denial Mitigation
Facility: BMHCC Corporate Office
Department: HS Denial Mitigation Corporate
Category: Finance and Accounting
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Located in the Memphis metro area