PFS Denials Manager

at NorthShore University Health System in Skokie, Illinois, United States

Job Description

Manager, PFS Denials

Position Highlights:
Position: Manager, PFS Denials
Location: Skokie, IL
Full Time
Hours: Monday-Friday, 8am-4:30pm
Required Travel: N/A

Job Summary

Reporting to the Director of Patient Financial Services, oversees the daily operations of the Denial Management Team for the legacy NS hospitals and Swedish, ensuring optimal performance in all areas of denial prevention and appeal processing in compliance with hospital policies and regulatory standards. Serves as subject matter expert for the denial appeal process and establishes denial prevention programs across NorthShore hospitals to mitigate losses from denials. Monitors state and federal regulatory agencies and payer information to maintain up-to-date knowledge on changing rules and regulations affecting denial prevention and management practice.

What you will do:
Manages the daily operations of the Denials Management program, overseeing the performance of the Denial Team. Oversees workflow and monitors productivity to ensure timely review of denials and prompt filing of appeals to meet payer deadlines. Conducts reviews, education, and audits to monitor and coach Denials Management staff regarding performance. Develops and maintains collaborative working relationships among Patient Financial Services, Health Information, Compliance, nursing and other departments and staff.
Functions as a resource for all departments in performance improvement opportunities related to denial management. Conducts monthly meetings; works with department leaders to develop denial prevention action plans. Analyzes and interprets denial data and trends in order to recommend process/procedural improvements and establish programs and processes for the denial team.
Oversees the management of RAC and government audit denials, ensuring that coordination and processes are continuously reviewed for accuracy and alignment with current Centers for Medicare/Medicaid Services (CMS) or other governing body recommendations and guidelines.
Interviews, hires, disciplines and discharges (when necessary) subordinate team members in accordance with Endeavor Health policies and procedures. Regularly evaluates the on-going performance of team members in accordance with the hospital's performance management system.
Organizes and conducts staff meetings to review data findings, discuss problems identified with system related issues, outcomes, standards of practice, and/or other related practice issues. Demonstrates accountability for outcomes through critical thinking and effective problem resolution. Follows through on all issues, challenges or roadblocks affecting the outcomes of the department.
Develops and prepares regular and special reports and analyses relating to the Denials Management process, service and productivity standards. Utilizes Finance and Revenue Cycle Key Performance Indicators to monitor performance outcomes. Formulates policies, securing appropriate approvals, and implements providing staff with interpretation and guidance to ensure consistency in implementation.
In consultation with the Director, assists in the development of short and long-term goals and initiatives, ensuring compatibility with the overall department and hospital objectives.
Identifies areas of denial management education opportunities for direct staff as well as ancillary departments.
Safeguards confidentiality of records according to State/ Federal regulations and hospital departmental policy. Adheres to all Endeavor Health standards, policies, and procedures.
Must comply and adhere to all Endeavor Health service values including, but not limited to working collaboratively and respectfully with all others while following through on commitments to internal and external customers, listening patiently without interrupting others, and must maintain a professional and calm demeanor under stressful situations.
Openness and willingness to perform all other job duties as assigned.

What you will need:
Education: Bachelor's degree in business or related field, preferred
Certification: N/A
Experience: 3-5 Years
Unique or Preferred Skills:
Excellent oral and written communication skills to effectively interact with internal staff and outside agencies individually or in a group setting in a service oriented manner.
The analytical skills necessary to collect and analyze data, identify problems, research regulatory topics, interpret federal regulations, and develop meaningful recommendations.
The leadership skills necessary to motivate employees utilizing a team approach.
The organizational skills to manage daily operations, coordinate multiple projects simultaneously, implement regulations and guidelines and monitor actions.
The mathematical skills necessary to comprehend financial... For full info follow application link.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.