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Denials Management Clinical Director in Altamonte Springs, FL at AdventHealth

Date Posted: 12/26/2018

Job Snapshot

  • Job Schedule
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
  • Travel
    Yes, 50 % of the Time
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Corporate

Job Description


Denials Management Assistant Director AdventHealth Corporate

Location Address: 900 Hope Way Altamonte Springs, Florida 32714

Top Reasons To Work At AdventHealth Corporate

  • Great benefits
  • Immediate Health Insurance Coverage
  • Career growth and advancement potential
Work Hours/Shift:
  • Full-Time, Monday – Friday

You Will Be Responsible For:

  • Responsible for all activities of personnel engaged in providing audit and clinical denials management activities, including significant expertise in workflows designed to optimize customer experience and maximize reimbursement.
  • Responsible for providing direction for clinical denials management functions and providing the manager(s) with the necessary tools to ensure the department operates effectively and minimize errors, rejections, and avoidable denials.
  • Responsible for formulating clinical denial management reporting and analytics strategies that can be applied consistently across the organization and collaborating with relevant stakeholders to determine priorities for the development of additional custom reporting and dashboard capabilities.
  • Monitor, analyze and assess clinical denial management trends and coordinate mitigation and denial prevention activities when opportunities for improvement are identified.
  • Participate in denials management committees and provide updates on clinical denials trends, issues and remediation plans. Devise new methods, procedures, and approaches to prevent clinical denials across the organization and be able to introduce and gain support for these process improvements.

What You Will Need:
  • Bachelor’s Degree (in Nursing, Business, Healthcare or Health Services Administration, Health Information Management, Communications, Finance, Accounting, Public Administration, Human Resources, Management, or Marketing)
  • Master’s Degree (in Nursing, Health Management, Business Administration, Finance, or other related area.)
  • Minimum of five years related work experience in utilization review, care management, revenue integrity, denial management, or clinical documentation improvement
  • Minimum of three years in a supervisory/managerial position in a similar-sized hospital
  • Current and valid registered (RN) license
  • Have a good understanding of payer requirements related to authorization and denial functions as well as reimbursement of all payers including but not limited to Government, Medicaid, Medicaid HMO products (i.e. VA, Tricare, Crimes Comp, Prisoners, etc.) and Managed Care / Commercial products
  • Comprehensive understanding of how Medicare DRG rates, Medicare APC rates, Medicare Fee Schedules, and Medicaid payments are calculated

Job Summary:


Under the direction of the Executive Director of Denials Management, the Clinical Denials Management Assistant Director oversees all audit and clinical denials management functional areas including denials appeals and prevention and is responsible for performance and effectiveness of the department accountable to meet and/or exceed financial and operational metrics established by AHS Leadership and proactively work to minimize errors and claim denials.

Directs manager(s) across the clinical denials management team to assure the integrity and stability of the performance of audit and denial related operations. Leads strategic planning to reduce clinical denials for the enterprise by coordinating the development of programs and processes to support targeted operational performance and mitigate financial and legal risks to AHS. Incorporates an awareness of the internal and external environment. Identifies, establishes, and implements internal controls to ensure a compliant environment. Serves as the point of contact for any issues or questions related to clinical denials and appeals for various external agencies, including state, local and federal governments, local community and the patients. Delegates responsibility and authority to carry out work. Initiates, leads, and facilitates enterprise work groups or complex projects. Manages and prioritizes limited resources across multi-disciplinary, multi-site teams to maximize efficiency. Travel required as assignments warrant.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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