Supv. Denials Management

Management San Marcos, California

Requisition ID
Revenue Cycle Mgmt
San Marcos, California
Not Applicable
Job Type
Hours Per Shift
Hours Per Pay Period

Responsible for the day-to-day activities of the Denials Management Team including summary and detailed level reporting and analytics, clinical appeals, root cause analysis and issue resolution. Interact frequently with denial analysts and leadership of the revenue cycle teams throughout the organization including but not limited to Patient Access, Patient Financial Services, Health Information Services, Utilization Management/Case Management, Charge Capture, Contract Management and Information Technology Services. Communicate with multiple members of the clinical team and various departments throughout Palomar Health. Responsible for organizing and supervising all work of the team members and ensuring timely clinical appeals and reporting. Responsible for supervision and distribution of root cause analysis for any issues or obstacles that result in denials and/or write-offs. Work requires a comprehensive knowledge of patient financial billing regulations/requirements, reimbursement, managed care; review, interpret and analyze patient financial reports and data; and plan, coordinate, and prepare for corrections to accounts; strong understanding of process improvement theory and techniques in order to affect positive change in reduction of claim denials. Requires advanced interpersonal skills necessary to work with physicians, hospital directors and managers to affect changes in clinical and fiscal operations, policies and procedures; to provide guidance, communicate and interpret complex patient billing and compliance information. Provide training and competency evaluation of team members as it relates to specific job functions and responsibilities.

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.

Job Requirements

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.