Director, Denial Transformation Services- Remote

Job Purpose

The Director of Denial Transformation Services develops and assists with leading the strategy to improve yield performance through denial mitigation process improvement initiatives. The Director of Denial Transformation Services will collaboratively work with clinical and revenue cycle department leadership to perform deep dive analysis on clinical and technical denials for their respective client(s), utilizing multiple analytics tools and data sources to identify trends and opportunities for improvement relative to all denial types. The Director of Denial Transformation Services applies high level critical thinking skills to perform root cause analysis on denied accounts to identify denial trends. Trends are then reviewed and sampled to guide clients through assessments of operations and preparation and development of policies, procedures, and tip sheets that assist in remedying the identified root causes. This position is client-facing and oversees completion of denial prevention committee reports and summaries for their assigned client base, leads monthly denial prevention committee meetings, is the primary contact for assigned client(s) on all denial issues, establishes and maintains client relationships to drive best practice implementations, and utilizes sound judgment and experience to aggregate and advance team recommendations for correcting underlying issues resulting in denials.

Duties and Responsibilities

• Provides relevant guidance and works to resolve issues identified through analysis of denial trends.
• Reviews individual denials to determine why they occurred.
• Professionally and effectively communicates with hospital contacts to recommend corrective and denial preventative actions and coordinates meetings and training sessions, as necessary.
• Participates in Denial Prevention Task Force or Committee with assigned client leadership, covering necessary information relative to identified denial trends, progress from prior actions, and next steps.
• Establishes strong relationships with appropriate stakeholders/committee members, including Finance Leadership, Revenue Cycle, Managed Care, and hospital department leadership teams.
• Oversee documentation and trends prevention-related findings to track results of executed denial mitigation plans.
• Initiates or contributes to the creation of reports as needed with the goal of providing relevant management information for tracking and trending problems and measuring improvement against best practices benchmarks.
• Leads reviews using all patient accounting, host and related systems used across their client to verify and summarize trends concisely with recommendations for corrective actions.
• Aggregates and provides strategic advisory perspective related to process improvement and quality in the assessment of root cause issues contributing to denials by collaborating with the subject-matter experts and applicable owners to make recommendations to remedy process, system, and education issues.
• Utilizes materials and trains revenue cycle staff, leadership, committee members, and hospital department leaders on denial-related trends and root cause issues impacting their client.
• Performs other duties as assigned.
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with the Health Insurance Portability and Accountability Act (HIPAA) standards.
Qualifications

• Required Minimum Education:
• Bachelor’s Degree or work equivalency
◦ Specialty/Major:
▪ Business or related discipline
• Preferred Education:
◦ Healthcare Administration, Business, or related discipline
• 5+ years of experience in hospital revenue cycle roles
◦ 2+ years of experience in a management position in hospital revenue cycle industry
• Background and familiarity with various Hospital Accounting and EMR Systems
• Solid ability to analyze, interpret and present data in meaningful ways.
• Other Knowledge, Skills, and Abilities Required:
◦ Project Work, Intermediate to Advanced Excel & Access Skills
• Other Knowledge, Skills, and Abilities Preferred:
◦ Project Management, Data Analytics
• Licensure/Certification Preferred:
◦ Certified Revenue Cycle Representative (CRCR)
Working Conditions
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as a computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and manage stress.
• Work Environment: The noise level in the work environme