Denial and Development Lead

Nemours is seeking a Denial and Development Lead (Full Time), to join our team in Jacksonville, Florida.

The Denial and Development Lead will serve as a lead for the reimbursement teams. This position has two primary functions. The first is to assist in the initial onboarding and training of new hires and associates who need refresher training.  The position is responsible for making and implementing a training plan for new hires, showing them the ins and outs of reimbursement and how reimbursement is followed up on in the CBO. In addition, this position would be asked to create and teach classes to the team. The second function, to be done if no training needs are noted as needed by supervisor/manager,  is to serve as a denial lead reporting to the designated leader, this person would use their knowledge of the revenue cycle to analyze, report and work reimbursement issues with various internal departments and external entities at all levels to create reliable methods for future resolution, i.e. pulling and analyzing reports, working AR, and reporting trends. 

This position is responsible for the following: 

• Make and implement training plan for new hires, as well as training plans for new processes, or established team members who may need additional training, including training classes. 
• Proficient knowledge of how people learn and how to tailor training to different learning styles. 
• Manage all onboarding requirements for new hires, such as a desk (if in office) and tickets for all necessary system, phone and website access.
• Acts as resource for questions and training the reimbursement teams reporting up to the designated supervisor or manger to which this position is assigned.  Fill in for reimbursement team or supervisors who may be out on leave. 
• Assist supervisor/manager with audits of reimbursement team accuracy in order to provide additional training or clarity on processes.
• Understand and apply principles of reimbursement to all aspects of the revenue cycle including but not limited to billing, coding, reimbursement, recovery, and patient responsibility. Including a thorough knowledge of current contracts, including reading, understanding, and applying contractual language to a claim. 
• Analyze third party denials and prepare relevant reports regarding trends and denials. This position will obtain, manipulate and analyze data from a variety of sources, including but not limited to: physician billing systems, hospital billing systems, contract management systems and claims systems. Then in turn have the ability to pursue additional payment from payors on underpayment discrepancies through various means of communication including verbal and written platforms i.e. email, appeals, etc.
• Apply problem solving skills to resolve discrepancies while maintaining a professional demeanor that promotes patient, staff and customer satisfaction, and reflects the Mission, Vision, and Values of Nemours when working with either insurers or the insured.
• Strong leadership skills that inspire the cooperation and confidence of peers and superiors. Proven history of excellent performance in achieving set goals. Demonstrated ability to identify, analyze and solve problems. Must be able to demonstrate an understanding of project management tools, methodologies, and techniques.
• Attend monthly payor meetings and phone conferences. As well as any additional miscellaneous duties, and responsibilities, as may be assigned from time to time by employee’s manager.
• Assist with creating, obtaining, and maintaining policies and procedures necessary to enhance the function of the department and its employees.
• Identify and report trends to CBO and Front-End Management regarding training issues
• Assists Manager with any other projects needed, such as – insurance audits, litigation needs, etc.
• Adheres to all related organizational and departmental policies.
• Foster a positive work environment with open communication to achieve mutual understanding within the team.
• Other duties as assigned.

Job Requirements

• High School Diploma required. 
• Reimbursement experience required.
• Three years of experience required. 

Nemours Children’s Health is an internationally recognized children’s health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children’s hospitals — Nemours Children’s Hospital, Delaware and Nemour