The Denials Mitigation Manager manages the daily operations of the Denials Mitigation team to ensure that denials are addressed 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 denials 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. 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 Director, Revenue Cycle.Responsibilities
1.Responsible for overall operational management of the REU - Oncology Department.
2.Oversees all activities related to monitoring, appealing, and resolving medical claim denials received from insurance carriers and Medicare/Medicaid.
3.Oversees day-to-day management of the denial staff to include training, monitoring of compliance and quality, establishing individual and team performance measures, recruiting, hiring/terminating, conducting performance reviews, and establishing goals.
4.Collaborates with the Director/Revenue Cycle Team in the resolution of treatment and services denied by Medicare, Medicaid, Tricare, commercial payers, and Managed Care organizations.
5.Responsible for generating monthly reports documenting denials appealed and resolved, analyzing trends and communicating appeal outcomes to the Director/Revenue Cycle Team for appropriate actions.
6.Recommends and implements departmental policies, procedures, and methods to increase the overall effectiveness of the denial management program.
7.Coordinates processes for collecting, organizing, analyzing and reporting data to enable leadership and others to make appropriate decisions to improve the denial mitigation process.
8.Works with internal and external customers to identify opportunities for improvement, which result in enhanced denial management services and customer satisfaction.
9.Performs other duties as assigned and directed.
Contributes to a positive work climate and the overall team effort of the departmentRequirements, Preferences and Experience
Bachelor's degree in healthcare, business administration, or Nursing
Three to five years management experience required; financial analysis, denial management, contract management, or financial services experience preferred
Basic understanding of Revenue Cycle functions, flow, and operations strongly preferred.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: 17236 - System Manager, REU- Oncology
Facility: BMHCC Corporate Office
Department: HS Corporate Finance Admin Corporate
Category: Finance and Accounting
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Located in the Memphis metro area