Director, Denials Management and Prevention - HB

AcclaraRemote, United States


Description

Hey there! We’re Acclara.    

As a remote-first workforce with team members in all 50 states, we’re a unique group of strategists, technologists, and service providers—all united in serving our partners to deliver the best care to their patients, helping build even healthier communities for us all to live and work in.    

We bring our one-of-a-kind selves to work each day, and we welcome (and want) you to do the same. Coffee connoisseurs, moms and dads, runners, animal lovers, adventurists—the list goes on—we all came to make a difference, and we stay because we’ve found a place where we don’t have to do it alone.    

Our team’s work is fueled by our CORE values of Commitment, Outcomes, Respect, and Empowerment. They’re the “how” behind what we do, guiding our actions as we aim to change the way technology and services come together.    

The Role    

The Director of Denial Management and Prevention is responsible for directing and administering the operations, programs, and activities of a centralized denial recovery operation, ensuring that processes and data meet regulatory requirements and policies. The Director will lead planning and execution of strategic initiatives around technical (administrative) and clinical/ medical necessity denials, payer relations, and hospital site collaboration.       

What You’ll Do    

  • Appeals related to payor authorization/pre-certification and medical necessity justification.
  • Appeals at second level, ALJ level and/or in a state or federal court and/or agency.
  • Denials Management, tracking, monitoring and overturning denials to improve revenue cycle performance for both inpatient and outpatient claims.
  • Oversight of technical billing and coding for CCI and LMRP edits.
  • Understanding of payer policies, procedures, NCD’s and LCD.s.
  • Audits, monitors and trends denials and recoveries identifying performance and areas of opportunity including system, chargemaster, coding and manual input.
  • Collaborate with key stakeholders identifying denial trends and process improvement opportunities, developing and applying process improvement methodologies in evaluating and improving appeal outcomes.
  • Mastery of PowerPoint presentations, for client presentations.
  • Oversee client denials prevention deliverables in partnership with both internal and external business relationships. Consult with appropriate key stakeholders when issues arise, develop, and communicate action plans and provide ongoing updates to all appropriate parties.
  • Partner with enterprise operations leaders, recommend and implement changes to processes, tools and/or methodology to ensure continuous improvement in operational efficiency and quality of services being delivered while achieving operational budgets.
      

What We’re Looking For    

  • Bachelor’s degree in accounting, Business Administration, Finance, Science, Nursing, or a related field or equivalent education and experience.
  • 7-10 years of progressively responsible experience in hospital receivables/operations management or integrated healthcare delivery system.
  • 3-5 years of management experience.
  • Prior work experience must include revenue cycle management projects and/or responsibilities, and a significant role in a redesign project and/or management experience working in a highly automated, centralized business office environment.
  • Advanced knowledge of Access, SQL, data warehouse, and reporting systems.
  • Experience with analysis and aggregation of health care claims and 835 Denial data.
  • Experience in dealing with very large data sets.
  • Experience with determination of root cause and correction of process or system issues causing denials and short pays.
  • Knowledge of the content, structure and maintenance of the charge master and fee schedules.
  • Experience in working with offshore vendors and building relationships.
  • Knowledge of various hospital and professional fee coding systems including CPT, HCPCS, APC, ICD10 and DRGs.
  • Experience managing and integrating global teams.
  • Experience managing P&Ls (enterprise level, client level, service line level)

     

Preferred Qualifications    

  • Master’s Degree in Business Administration or Health Administration
  • Six Sigma / Black Belt

How We Take Care of Our Team Members    

  • Remote-first workplace, with opportunities to work on-site in certain locations
  • Comprehensive medical, dental, and vision coverage
  • Parental leave
  • 401K with company match
  • Company-paid life insurance, short-term disability, and long-term disability
  • Paid time off and holidays

Pay Range: $90,000 - $147,000    

This compensation range is a reasonable estimate that extends from the lowest to the highest pay Acclara in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. Acclara may ultimately pay more or less than the posted range as permitted by law.    

Diversity, Equity, and Inclusion Matter    

At Acclara, you’re invited to bring more of yourself to work—not less. Your background, your culture, and your personal experiences are all important pieces of the authentic you, and we honor that. Connection is created when we show up.    

Acclara, an R1 company, is dedicated to the fundamentals of equal employment opportunity. Acclara’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, Acclara is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.    

If you need reasonable accommodation due to a disability for any part of the interview process, please contact [email protected].    

Visa Sponsorship is not available at this time.