Manager - Denials Management in Garden City, MI at Garden City Hospital

Date Posted: 7/7/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    6245 Inkster Road
    Garden City, MI
  • Job Type:
  • Experience:
    Up to 5 year(s)
  • Date Posted:
    7/7/2019

Job Description



Overview

JOB SUMMARY: The Manager, Denials Management is responsible for the overall management of the denials process. The Manager, Denials Management will be responsible for evaluating and managing all processes to ensure efficiency as well as developing, managing and implementing new process to meet the organization’s needs. The Manager, Denials Management will develop and manage initiatives to ensure the operations of the denials management team is in line with organizational goals. The Director will interpret and implement complex rules and regulations governing insurance, appeal activities, trends, etc. to make recommendations. The Manager, Denials Management will maintain a good working relationship with all facilities and ensure clear communication. Effectively interacts with patients, other health team members, and physicians while maintaining a standard of professionalism.

 

 

 

Responsibilities

DUTIES AND RESPONSIBILITIES1. Oversees the facilitation of the denial and appeal process, identifies, develops, and implements process improvement methodologies. 2. Performs all department functions, as necessary. 3. Assists staff in resolving department problems. 4. Completes all employee evaluations timely. 5. Monitors employee attendance; insures employees attend Mandatory Education and other programs or training as required by the facility 6. Provides timely responses to Administrative/other requests. 7. Ensures that the overall operations of assigned services promote effective interdisciplinary teamwork that results in high quality, cost effective, and coordinated services which are responsive to the needs of patients, patient’s family members, physicians, employees, administration, other departments, and appropriate external organizations 8. Assures department staff is scheduled according to department policies. 9. Develops and implements strategic plans, unit/department goals and objectives, business initiatives, and supporting financial plans and budgets; complies with all policies/procedures, applicable laws, regulatory agency requirements, codes of practice and organization work standards; assumes responsibility for decisions made; communicates effectively with all in and outside the organization to ensure prompt and proper information exchanges and issue resolution; is a coach and role model for staff and colleagues creating a work environment that fosters respect and positive morale and strong employee engagement 10. Demonstrates 24 hour accountability for department needs. 11. Analyzes monthly reports and identifies interventions as appropriate. 12. Identifies problems and counsels staff in a timely and equitable manner. 13. Documents all counseling/disciplinary activities according to Human Resources policies and procedures. 14. Reviews role expectations for prospective employees during the interview process using job description, department standards and policies 15. Provide reports to CBO, Finance, and Administration as needed. 16. Consistently evaluates, educates, motivates and assists the Business Office staff as need to achieve the following hospital goals: 17. Ensures cash goals are met. 18. Performs all other duties as assigned or required.

Qualifications

 

EDUCATION, EXPERIENCE, TRAINING1. Two to five years of progressive experience in appeal/denial management\u2013 Required2. Three to five years management experience preferred.3. Excellent communication and interpersonal skills 4. Strong analytical skills required 5. Advanced computer skills required6. Strong knowledge of health plan requirements7. Bachelor’s Degree preferred

 

 

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf

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