Denials Management Clinical Director in Altamonte Springs, FL at Adventist Health System

Date Posted: 10/26/2018

Job Snapshot

  • Job Schedule
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
  • Travel
    Yes, 50 % of the Time
  • Shift
    1 - Day
  • AHS Zone
    1-Shared Services
  • Organization
    Adventist Health System Corporate Office

Job Description

Work Hours/Shift

Full Time, Monday-Friday

Adventist Health System Corporate Office

Be part of the Adventist Health System family.

Where you work matters. Working here is like being part of a family. Not just with those you serve, but also with your team members. It’s about making a difference, saving lives, and helping others live a fuller one. You’ll be joining a family of tens of thousands of team members who understand that what they do is bigger than healthcare. It is living out our mission to Extend the Healing Ministry of Christ and being there for someone every step of the way-body, mind, and spirit.

This is more than a career. It is a calling.

With hospitals and facilities in 9 states, you’ll have endless opportunities to take your talents, develop your skills, and grow as a professional in a place that truly cares about your success. If you are driven, compassionate, someone who always wants to go above and beyond because you care and believe what you do makes a difference – Adventist Health System is for you.

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.

What 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.
  • Responsible for understanding the interdependencies of the AHS structure and defending AHS’s interests to both internal and external stakeholders.
  • Empowers team leadership and staff to develop methods of process improvement, including planning, setting priorities, conducting systematic performance assessments, implementing improvements based on those assessments and maintaining achieved improvements.
  • Translates AHS and revenue cycle divisional vision into meaningful and effective responses and results. Provides direction for complex business decision making to support outcomes aligned with established strategic, operational, and financial goals/targets.
  • Responsible for working with other AHS stakeholders to implement system-wide initiatives across people, process, technology, and strategy considerations to optimize and streamline proactive denial & follow up processes and well as promote consistency/standardization.
  • Consistently demonstrates and encourages a commitment to quality, customer-centeredness, productivity and continuous improvement. Consistently, demonstrate comprehensive and thorough understanding of all elements of health care delivery, including strategy, business planning, employee and third party agreements, operations and financial conditions.
  • Performs other duties as assigned by leadership.
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 nurse (RN) license if degree is in nursing

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

Location | Organization | Category | Job Function