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Position Summary:

Responsible for assisting the Corporate Director Denials Management in providing regional management of day-today operation and workflow of the denials management team.

Builds strong partnerships with service lines, key physicians, and other interdisciplinary departments/leaders to reach the goals and objectives of the denials department to ensure quality outcomes and revenue integrity.

Essential Functions and Responsibilities:

1.

Provides regional management of operations, including assisting with performance management and resolving staff problems.

2.

Provides orientation and training for new staff and providers, ongoing education/development for the denials management team and the organization regarding national and regional trends.

3.

Provides trends and direction to assist front-end processes such as utilization management, clinical documentation improvement, coding, and billing etc. to reduce denials.

4.

Assists in the development of denials management processes, policies, and practice standards.

5.

Assists with managing the revenue cycle by reducing clinical denial write offs

6.

Assists in running reports and utilizes tools for reporting trends and identifies opportunities for potential denials management impact on medical necessity and clinical validation denials and assist with vendor tool management.

7.

Oversees maintaining an accurate database of all denial activity to closure to help manage and track denial hand-offs between departments.

8.

Communicates with MHC subsidiary leadership to support denials initiatives, dashboard metrics, and key performance indicators (KPIs).

Qualifications:

_Required:_

+ Associate’s degree in nursing or healthcare related field

·

Current Registered Nurse license in the state of Michigan or possess a Doctor of Medicine Degree

·

4 years of utilization management, case management, clinical documentation, and/or denials/appeals experience in an acute healthcare facility

·

American Case Management Certification (ACM), Certified Clinical Documentation Specialist (CCDS) or Certified Coding Specialist (CCS)

_or_

obtain certification when eligible as defined by the appropriate credentialing body/association,

_and_

maintenance of continuing education requirements.

_Preferred:_

+ Bachelor’s degree in business, nursing, or a health-related field

+ 2 years of experience in supervisionExperience in Case Management, Clinical Documentation, Critical Care, or Quality

+ Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training network (MTN)