Associate Manager RN Denials Management - Remote Eligible

Associate Manager Of Rn Denials Management

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As an Associate Manager of RN Denials Management, you will be an integral part of leadership within the team. During your typical duties, you will have the opportunity to educate and develop team members, roll out process changes and projects, as well as troubleshooting questions from your team and outside stakeholders, and conducting review of findings.

In this role you will have 10-12 direct reports who will be working centralized denials management for our 31 Banner facilities. A typical day would include overseeing RN denials mgt specialists and Audit team, posting bill reviews, and managing workflow and queue designation. The team is very independent and work remotely.

Location: Remote, Banner supplies equipment

Schedule: Exempt, Mon-Fri 8am-4:30pm AZ Time (No Weekends or Call)

Ideal Candidate:

• Must have at least 5 years experience as an RN, with current licensure in state of practice;
• Must have a bachelors degree or equivalent experience;
• At least 2 years of leadership, including Direct Reports;
• Ideal candidate will be experienced in Denials Management, Case review, and understanding of insurance.

This can be a remote position if you live in the following state(s) only: AL, AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NY, NM, NV, OH, OK, OR PA, SC, TN, TX, UT, VA, WA, WI, WV, WY

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines.

POSITION SUMMARY

This position provides leadership, direction and support in response to denials from federal, state and commercial reimbursement programs. Provides leadership in clinical, financial, and personnel management within the department to result in overall reduction in payer clinical denials. Collaborates with Care Coordination, physician, Utilization Review, and other internal/external departments to overturn and/or reduction of payer denials. Reviews internal department practices and standards with staff to ensure maximum reimbursement while ensuring the provision of high quality, safe, and cost effective patient care. Demonstrates account denial and appeal review expertise and oversees the leadership of clinical, financial, and personnel management of the assigned department. This position supervises employees and participates in selection, orientation, counseling, evaluation and staff scheduling. Maintains clinical, leadership and post-acute care services knowledge and competency to evaluate denial and/or appeal outcomes related to delivery of clinical services.

CORE FUNCTIONS

1. Oversees the operations of the team to ensure smooth and efficient payer denial and/or appeal review. Assures appropriate team assignments. Completes daily rounding on team members to ensure quality reviews of payer denials and/or appeals. Accurately and thoroughly completes documentation required for claims payment of services approved through concurrent review

2. Supervises the team to ensure internal/external client and employee satisfaction while promoting quality denial and/or appeal reviews and retention. Serves as a real-time resource and assists with clinical expertise for team members and physicians for problem-solving on various denials and/or appeals related patient services, processes, and specific denial issues. Identifies educational needs regarding payor issues, functions as preceptor, and provides appropriate education.

3. Develops leadership skills among staff including communication, decision-making problem-solving/critical thinking and employee engagement. Leads the development of staff and supports career advancement opportunities. Functions as a role model and encourages staff to participate in their own development. Responsible for selection, orientation, on-boarding, and retention. Demonstrates leadership through coaching, performance evaluations, corrective actions, and development opportunities to create a culture of learning.

4. Assists in the daily operational resource management including staff, approve/edit time cards, supplies, and equipment, and ensures optimal productivity for the department. Tracks, monitors and documents denial causes and resolutions with appropriate management staff.

5. Builds and continually updates a knowledge of payer requirements for covered treatment protocols by diagnosis, approval requirements for procedures, and coverage norms.

MINIMUM QUALIFICATIONS

Requires a level of education as normally demonstrated by a Bachelor's degree.

Requires Registered Nurse (R.N.) licensure in the state of practice.

Requires experience in federal, state and commercial reimbursements and in reviewing clinical information typically acquired in three years auditing DRG coding and reimbursements. Requires five or more years of clinical nursing and/or related experience. Experience in hospital operations, reimbursement methods, medical staff relations, and the charging/billing is required. A working knowledge of utilization management and patient services is required. A working knowledge of medical and third party payer requirements and reimbursement methodologies is required. Highly developed human relation and communication skills are required. Must demonstrate critical thinking, problem-solving, effective communication, and time management skills. Must demonstrate ability to work independently as well as effectively with team members. Must have developed leadership skills, interpersonal skills and the ability to work collaboratively in a matrix model as normally demonstrated through increased scope with project work, stretch assignments, progressive scope and complexity.

PREFERRED QUALIFICATIONS

BSN preferred. Additional related education and/or experience preferred.