Job Description

Job Summary 

Responsible for managing appeals and denials staff in processing accounts and working with designated payors to ensure proper reimbursement, maximize cash flow, and reduce aging accounts receivable. 

Essential Functions

Ensures compliance with state and federal laws and regulations. Maintains a thorough understanding of health insurance and government programs, where necessary. Maintains understanding of contracts and works with corporate on contractual issues as needed. Facilitates the identification of issues and solutions by team members related to delays in achieving payment resolution and, in identifying trends of denials seen to prevent ongoing losses. Monitors collection of appealed accounts to maintain timely collections of cash. Works with all other department managers to identify department training needs for system education, industry updates and changes in collection processes and protocols. Works with Director and staff to ensure that employee productivity and quality meets standards. Manages workflow, employee productivity, and collection efforts for assigned team. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

H.S. Diploma or GED required Bachelor's Degree required Master's Degree preferred 3-6 years Previous experience or training in healthcare business office policies, practices and procedures required 3-6 years Related experience in denials and appeals required 2-4 years Supervisory experience required

Knowledge, Skills and Abilities

To perform this job successfully, an individual should be proficient in and/or able to easily learn multiple software programs, including Word, Excel, and Google suite.