Senior Director – Denials Management – Revenue Cycle

Senior Director – Denials Management – Revenue Cycle

Requirements

• Bachelor’s Degree preferred.
• High school diploma or GED required.
• 10+ years’ experience in management or supervisory experience.
• 8+ years’ experience in healthcare field working.
• 7+ years’ of client facing/customer services experience.
• Comfortable understanding of insurance payer/provider claims processing.
• Equivalent combination of education and experience will be considered.
• Strong working knowledge of data analysis and performance metrics using business management software.
• Extensive level of understanding of insurance payer/provider claim processing and subsequent data requirements.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Maintain a current working knowledge of all related HIPAA regulations and ensures staff compliance to these requirements.

Responsibilities

• Acts as a subject matter expert in EnableComp Denials related products.
• Conduct product opportunity research to determine efficacy and profitability based on cost models.
• Research and development of innovative products enabling EC to advance within the industry, increase profitability, and grow as a company.
• Act as a key resource during the implementation of the new products.
• Identify, research, and develop new business opportunities within the scope of the department.
• Assist with department’s business strategy alongside the Vice President, Complex Claims.
• Create and manage training materials and presentations to support departmental growth, best practices, and increased revenue.
• Participate and lead aspects of product implementations while identifying improvements and opportunities.
• Develop or enhance operational processes within the Denials Department to drive efficiency with focus on quality.
• Assist with the creation, communication, and training of new department products, process changes, and operational best practices.
• Create, define, and modify processes for general client denials inventory and performance management, communication, reconciliation processes, and client/executive denials reporting.
• Manage a team of CC Project Coordinators, responsible for hiring and staffing of this department as business needs dictate.
• Work closely with Analytics team to analyze incoming files for data integrity, revenue opportunity, and client feedback.
• Assist Implementation team with implementation/client onboarding, team member access related issues, and new client or product related projects.
• Communicate with EC team members to identify and define denial project related requirements and scope.
• Responsible for organizing and tracking escalated issues, including communicating action plans for resolution with senior management stakeholders and senior leadership at EnableComp.
• Act as liaison between Client and department for special projects, issue resolution, and any other client or department needs.
• Manage a portfolio of Client Project Dashboards, issue resolution, action plans and related processes.
• Lead Client performance reviews, quarterly business reviews, and related performance-based meetings via teleconference and/or onsite directly with decisionmaker-level executives.

Preferred Qualifications

• Proven ability to meet and/or exceed productivity targets and goals.
• Maintains stable performance under pressure or opposition.
• Proven success in setting priorities for direct reports.
• Must be a self-starter and able to work independently without direct supervision.
• Proven written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Proven experience working with external clients; strong customer service skills and business acumen.
• Ability to prioritize and manage multiple competing priorities and projects concurrently.