Lead,Contract and Denial Management in Santa Fe Springs, CA at Avanti Hospitals

Date Posted: 4/30/2018

Job Snapshot

Job Description

Central Business Office

Job Title: Lead,Contract and Denial Management 

City: Santa Fe Springs / State: California    

Patient Accounting

Day Shift

From 8:00 AM

To 4:30 PM

                                      


Job Description and Job Responsibilites

Job Title:  Lead, Contract and Denial Management

Job Summary: 

 

Position is responsible for day to day review, coordination and management of technical denials requiring background and understanding from a provider operational and payer logistical perspective. Review denied accounts, prepare appeal, discuss denials with payer representatives and monitor outcomes of follow-up activities. Works closely with the Clinical Denial Manager and Collection Units on nuances associated with denials of a clinical nature. Represents Avanti Hospitals from a system perspective when working with payers to challenge and overturn denials of a technical nature. Manages overturn rate data and evaluates trends for improvement opportunities. Provides leadership within the department and training to new employees. Support to Manager to input contracts within the Contract Management system. Works as part of the team to develop meaningful information for Hospitals and other stakeholders to improve operational performance and cash collections.  Reports to Manager, Contract and Denial Management

 

Essential Job Duties: 

  • Evaluates all technical denials for possible overturn opportunity. Prepares Appeals as required. Works closely with payers both on the phone and through electronic means to resolve denials and receive payment on accounts.

  • Works as part of a team to develop and administer all technical denial workflows and processes.

  • Works closely with Clinical Denial Manager and Collection Manager to review cases and provide guidance in understanding the interplay between clinical and technical denials

  • Tracks and manages denied accounts, including triaging denials with the Clinical Denial Manager and Collections Manager to quickly and expeditiously evaluate collectability.

  • Based on initial review of accounts, manages various “buckets” of issues across Hospitals to resolution.

  • Identifies and escalates consistent issues and trends with payers to support Leadership when meeting with payers to resolve issues.

  • Provides fact-based information to Leadership on a regular basis on technical denial performance with recommendations on process improvements to avoid denials in the future.

  • Provides leadership within the department and training to new employees

  • Assist with loading of contracts within the Contract Management system.

  • Complies with Federal, State, and Local Laws that govern business practices.

  • Understands and abides by all departmental policies and procedures as well as the Code of Ethics, HIPAA requirements and patient rights.

  • Performs other job related tasks, and special projects as assigned.

Behavioral Standards: 

  • Exhibits customer and service oriented behaviors in every day work interactions.

  • Demonstrates a courteous and respectful attitude to internal workforce and external customers.

Communication/Knowledge:

  • Provides accurate and timely written and verbal communication of information in a manner that is understood by all.   

  • Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.

  • Able to use IT systems in an accurate and proficient manner.

Collaboration/Teamwork:

  • Contributes toward effective, positive working relationships with internal and external colleagues.

  • Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.




Job Requirements

Education/Experience:

  • BA/BS desired, with work experience in lieu of degree acceptable.

  • A minimum of 5 years healthcare experience if no degree, with understanding of managed care contracts, provider operations and/or payer operations. Experience in negotiations valuable.

  • A minimum of 2 years of healthcare experience if degreed.

  • Analytical skills required

  • Excellent knowledge of applicable rules/regulations/guidelines governing Managed Care and Government sponsored coverage and

reimbursement.

Licensure/Certifications:

  • CPAT preferred

ADA/Physical Demands:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.

  • Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell.  The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.

 

Job Requirements

Education/Experience:

  • BA/BS desired, with work experience in lieu of degree acceptable.

  • A minimum of 5 years healthcare experience if no degree, with understanding of managed care contracts, provider operations and/or payer operations. Experience in negotiations valuable.

  • A minimum of 2 years of healthcare experience if degreed.

  • Analytical skills required

  • Excellent knowledge of applicable rules/regulations/guidelines governing Managed Care and Government sponsored coverage and

reimbursement.

Licensure/Certifications:

  • CPAT preferred

ADA/Physical Demands:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.

  • Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell.  The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.

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