Supv. Denials Management
This position is also responsible for overseeing the department quality, audit, and training programs. Responsible for performing staff quality reviews and auditing, ensuring staff performance aligns with department policies and expectations. Coordinates the development, implementation, and evaluation of the overall quality monitoring and improvement, to identify trends, prioritize and recommend improvements, decrease duplication, and ensure compliance of state and federal regulations. In collaboration with the PFS manager, creates and oversees department training programs, reference tools and policies. Frequent interaction with system vendors as well as outsourced agencies and third party payer groups. Analyzes various new regulations, bulletins, manual updates as they relate to Medicare and Medicaid, to identify potential situations impacting net revenue/cash collections and provides recommendations with respect to the appropriate required response or action. Generates and analyzes Accounts Receivable and Denials reports that are distributed to the department and organization on a routine basis, and is knowledgeable of the contents.
Speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, Powerpoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.
|Minimum Education:||Associate's degree in Management or related field|
|Preferred Education:||Bachelor's degree in Management or related field|
|Minimum Experience:||3 Years of billing and supervisory experience in both Commercial and Government payer reimbursement, with knowledge of regulatory guidelines in both billing and claims adjudication. Advanced use of Excel, Word and PowerPoint|
|Preferred Experience:||5 Years of billing and supervisory experience|
|Required Certification:||Not Applicable|
|Preferred Certification:||Not Applicable|
|Required License:||Valid Driver's License|
|Preferred License:||Not Applicable|
We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.