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

Date Posted: 11/9/2018

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.

The Denials Management Supervisor directs and manages staff in performing denial and underpayment related activities including customer service, processing insurance claims, expediting billing and payments for insurance claims, performing outgoing calls and correspondence to patients and insurance companies, denials management and appeals for accurate billing, resolving claim adjudication issues and responding to audit requests. 

The Supervisor is responsible for the performance of their team and holds each staff member accountable for the performance of assigned day-to-day activities, to include ensuring effective use of computer equipment and materials within departmental budget and quality standards. Monitors staff productivity levels, quality of output, and resolves workplace-related issues in a timely manner to promote a culture of accountability driving towards continuous performance improvement. Serves as a liaison to other revenue cycle teams within AHS as well as external constituents/stakeholders. Participates in enterprise-wide projects, work groups, task forces, councils, and committees. This position may require occasional travel. Adheres to AHS Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

What you will be responsible for:
  • Responsible for assisting in the execution of workflow designed to optimize customer experience and maximize reimbursement for denials and underpayment management and appeals. Reviews work lists to verify they are being managed effectively and work assignments remain current.
  • Assists in tracking performance, measurement, monitoring, and reporting of denials management and underpayment functions aligned with established management targets/KPIs. Assists in presenting current state performance to leadership, to include identification of process bottlenecks; identifies critical decisions that need to be made across multiple stakeholders to align performance to management expectations.
  • Applies methodologies to measure and analyze volume trends, quality, and staff productivity of assigned work areas. Provides timely feedback to staff based on evaluation of results. Prepares and presents meaningful performance appraisals to staff in a timely manner.
  • Assists in providing input for the annual budget and assures cost effectiveness of the work unit (staffing matches workload, develops and oversees applicable productivity measurements, reviews and verifies monthly financial/staffing statements)
  • Demonstrates effective decision making skills by defining the scope of an issue, identifying the stakeholders whose input is needed, creates and weighs alternative solutions and communicating outcomes. Assists in the creation of strategic plans and initiatives that reflect the department leadership plans using creative and innovative tools.
  • Participates in denials management committees and provides updates on denials trends, issues and remediation plans as needed.
  • Responds to suggestions from internal customers/staff. Creates a cooperative and productive atmosphere by modeling how to work collaboratively across departmental lines.
  • Maintains an up to date knowledge of department policies and procedures; responsible for external changes made based off future state revisions to processes.
  •    Performs other duties as assigned by management.
What you will need:
  • Associate’s Degree, or higher
  • Current and valid registered nurse (RN) license if degree is in nursing
  • Minimum two (2) years denials management experience in a revenue cycle department or related area (registration, finance, collections, customer service, utilization review, case management, medical office, or contract management).
  • One (1) year supervisory or management experience
  • Have a good understanding of insurance reimbursement related to 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

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