Mgr., PFS Denials/Collections

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Manages and controls all processes related to Denials Management in the Inpatient, Outpatient (COPC and Specialty Clinics) and Emergency areas. Denials/Collections Manager is responsible for providing oversight, management, reporting, prevention, and resolution of the denial inventory for Government, Managed Care, Non- Government, and Commercial plan payors. This candidate will trend denials for root cause analysis reporting, follow and create value added processes related to denials management, account reviews, and appeals management, and insurance follow up to maximize revenue recovery and denial prevention. Additional, Denials/Collections Manager is responsible for communication and collaboration with Clinical Department Leaders to mitigate denials wherever possible. 

MINIMUM SPECIFICATIONS

Education:

BA/BS Degree or higher in education, business administration, health administration or finance preferred or related work experience.

Experience:

 - Must have five years of Patient Financial Services or Coding experience, to include three to five years of experience in analysis and resolution of hospital denials and two years of experience in a lead role.

 - Must have experience with interpreting Medical Documentation and constructing effective appeal letters to overturn denials.

 - Must have strong working knowledge of medical terminology and strong knowledge of HCPCS Codes and ICD-10 Codes

 Equivalent Education and/or Experience:

 - May have an equivalent combination of education and experience to substitute for both the education and the experience requirements.

Skills or Special Abilities:

 - Must possess an expert level knowledge of PFS operations, including operations in a hospital healthcare environment.

 - Must be able to prioritize efforts to achieve strategic goals.

 - Must have excellent verbal and written communication skills.

 - Must be customer service oriented.

 - Must be able to think creatively and strategically in developing and implementing management procedures, goals and objectives.

Responsibilities:

1. The manager will be responsible for implementing short and long-term plans and objectives to improve revenue and manage overall denials trends.
2. Working with insurance companies to identify reasons for denied payment of services.
3. Work with patient Access, Coding, Billing ,Follow-Up and Clinical areas to identify, correct, and reduce denials trends related to their respective departments.
4. They will empower 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.
5. Coordinate with the Care Management Appeals team to ensure a smooth workflow is developed, implemented, and maintained for addressing medical necessity denials. As well as support payer relationships as needed.
6. Maintain denial inventory, appeals and follow up work daily to ensure timely appeals, rebills, and account reviews.
7. Counsel staff with disciplinary and productivity issues.
8. Contact insurance payers via telephone on aged/delayed/high dollars claims for resolution escalating as needed.
9. Assist with the onboarding and training of all new hires.
10. Communicates with all parties in a professional manner and provides explanations regarding the denial inventory.
11. Ensure confidentiality of all patient accounts by following HIPAA guidelines.
12. Adheres to compliance of CMS and other payer guidelines.
13. Responsible for being aware of the current department policies and procedures.
14. Review and follow adjustment requests and explanations timely and identified.
15. Meet or exceed quality and quantity benchmark targets as established by management (Productivity, Cash Collections, Past Due Follow Up) or other key performance indicators.
16. Communicate daily with upper management, patient access, case management, denial staff and other department heads regarding payor denial trends identified.
17. Assist denial team with resolution of aged difficult claims promptly.
18. Provide feedback and training to the denial team timely.
19. Flexibility to assist with appeals, denial inventory, and follow-up based on need regardless of payer.
20. Maintain complete and accurate follow up actions in the patient accounting system.
21. Establishes and maintains insurance payor, employer, vendor and provider representative relationships including the coordination of meetings to improve dialog and processes.
22. Maintains a working knowledge of insurance carriers, payers and processes utilized within the revenue cycle.
23. Ensure all processes and payment compliance policies are followed according to but not limited to audit requirements.
24. Timely and consistently reports project status to upper management/leadership.
25. Assist upper management/leadership in the development of staff, plans and goals.
26. Participants in all educational activities, and demonstrates personal responsibility for job performance. Organizes work/resources to accomplish objectives and meet deadlines.
27. Maintains a professional image and provides excellent customer service.
28. Attends department meetings and education sessions.
29. Meets/exceeds performance expectations within required time frames.
30. Practices and adheres to the Code of Conduct philosophy and Mission and Values statement.
31. Working knowledge of all facets of insurance claim filing, requirements and regulations.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.