"Alerted.org

Director Clinical and DRG Denials

**Location:** Larkin Bldg @ Exchange Street

Location of Job: US:NY:Buffalo

Work Type: Full-Time

**Shift:** Shift 1

Job Description

Summary:

The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue Cycle department. Directs performance improvement initiatives, develops and maintains operational policies for the department and assures regulatory compliance is a priority. Specifically, develops strategies and tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development and implementation of policies and procedures.The Director, Clinical & DRG Denials will work collaboratively with physicians, nursing staff, Quality, Finance and others to develop, implement and maintain strategies that capitalize on facility and industry best practices to achieve targeted outcomes.Identifies, communicates and holds staff accountable for performance expectations; monitors/appraises the job results/performance and promotes a positive, team-oriented work environment. Develops relationships and influences payer policies and procedures as well as facilitating strong working relationships between HIM, Clinical Documentation, UR, Physician Advisor operations, PFS, Contracting, and hospital departments and leadership to promote effective clinical validation improvement and clinical denial management system-wide. Significant influence on system quality and financial outcomes.

Education And Credentials

Responsibilities:

Bachelor degree in health related field required. MBA or MHA preferred.

Experience

Other information:

10 years of experience in Healthcare environment required. 8 years of experience in Insurance Carriers, Payer policy trends and Revenue Cycle management concepts required. 5 years of experience in a large, complex acute care setting in a supervisory /

administrative role required. 5 years of experience in Basic computer skills including Microsoft word, Microsoft excel with spreadsheet development and utilization, Microsoft outlook required. 8 years of experience in multi- hospital system and / or managed care required. 10 years of experience in Federal, state and accreditation guidelines, financial principals, reimbursement methodologies, coverage issues, documentation, coding conventions and insurance / managed care practices including but not limited to:

utilization review, RAC, MAC, Q10, clinical and DRG denial management required.

Working Conditions

Working conditions:

Essential:

* Weight Requirement - Light (up to 20 lbs)

Job Details

Department: KH Clinical Revenue Cycle Admin

Standard Hours Bi-Weekly: 75.00

Weekend/Holiday Requirement: No

On Call Required: No

**With Rotation:** No

**Scheduled Work Hours:** 8a-5p

Work Arrangement: Hybrid

Union Code: N00 - Non Union KH

Requisition ID#: 704

Recruiter: Constance M. Rollo

Grade: EX218

Pay Frequency: Bi-Weekly

**Salary Range:** $109,414.50 - $150,442.50

*Wage will be determined based on factors such as candidate's experience, qualifications, internal equity, and any applicable collective bargaining agreement.

_Kaleida Health’s mission is to advance the health of our community, and we believe our diversity, equity, and inclusion (DEI) strategic work is mission- critical for the good of our workforce and the community who need and depend on our care and services. We understand that racism and health inequities stand firmly in the way of advancing the health of our community, and Kaleida Health envisions DEI as the pursuit of equity and restorative justice for every person. We will exemplify courage and accountability through both the professing and practice of our core values for our friends, colleagues, and community. Kaleida Health is committed to creating a culture of equity and inclusion where diversity is valued and celebrated!_

**Position** Director Clinical and DRG Denials

**Location** US:NY:Buffalo | Management | Full-Time

**Req ID** null

Equal Opportunity Employer

Kaleida Health is committed to diversity and believes our workforce is strengthened by the inclusion of and respect for our differences.

Kaleida Health is an equal opportunity and affirmative action employer. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, religion, sex, national origin, citizenship status, creed, gender, gender identity or expression, sexual orientation, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for or perform your job.