POSITION PURPOSE

Supervises and coordinates the day-to-day denial team responsible for all post billed denials (inclusive of clinical denials and for ensuring payments are received on denied accounts, determining root causes of denials and preventing denials within the Hospital or Medical Group revenue operations of an assigned Patient Business Services (PBS) location.  Motivates staff to achieve the highest levels to meet the organization goals for customer service, operational and financial performance.  This position reports directly to the Manager Denials.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

Provide hands-on supervision and coordination of daily activities and workflows of the denials team handling the receipt, analysis, and appeals of denials received to achieve optimal area performance and colleague productivity goals as part of the revenue cycle process for an assigned PBS location.

Responsible for the oversight of denial management processes to appropriately maximize reimbursements based upon services delivered and to ensure the claims are paid/settled in a timely efficient manner, which includes resolution of complicated claims which have been denied.

Monitors final adjustments on completed denial accounts (either paid or final denied), and reviews documentation in appropriate system(s).

Reviews and tracks trends for the causes for denials and makes recommendations for problem and issue resolutions based upon colleague findings; reports findings to the Manager and Director of Denials and other PBS leadership.

Supervises communication and follow-up processes related to denials and ensures such activities are submitted tracked, trended and reported timely to key stakeholders.

Prepares service level metrics and explanatory summaries for the Manager and Director Denials and other PBS leadership.

Participates in the redesign of denial management processes and systems to improve service, data integrity, and staff productivity/quality to achieve departmental goals and process outcomes.

Identifies and participates in continuous quality improvement initiatives across the denials team and other functional areas to streamline processes.

Identifies and implements solutions to problems and issues affecting denials activities.

Evaluates potential new colleagues and make recommendations for hiring.

 Assists with the identification of training needs and coordinates with the department trainer to develop and conduct training programs, which includes on-the-job training.

Assists with establishing performance standards for denial colleagues. Monitors and tracks colleague activities against established performance standards and provides immediate feedback to achieve performance improvement.

Other duties as needed and assigned by the Manager.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

Must possess a comprehensive knowledge of revenue cycle functions and systems, as normally obtained through an Associate's degree in Business or Healthcare Administration or a related field, and minimum of three (3) years of experience within the area of revenue management, specifically experience with Denials or other functions related to revenue cycle activities or an equivalent combination of education and experience.  Experience in a complex multi-entity organization or large complex revenue cycle services preferred.

Exhibits supervisory skills that emphasize team‑building and strong leadership with the ability to provide clear oversight and coordination to the department, while also functioning as an individual contributor.

Supervisory or team leader experience preferred.

Strong written and verbal communication skills. Ability to communicate effectively with payors and work with all levels of colleagues to expedite revenue cycle processes while supporting customer service.

Effective critical thinking and problem-solving skills.  Ability to analyze data and prepare related reports and summaries.

Proficiency in Microsoft Office, including Outlook, Word, PowerPoint, and Excel.

Strong organizational skills supervising direct reporting relationships

Must be comfortable operating in a collaborative, shared leadership environment. 

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

This position operates in a typical office environment.  The area is well lit, temperature controlled and free from hazards. 

Incumbent communicates frequently, in person and over the phone, with people in all locations on product support issues. 

Manual dexterity is needed to operate a keyboard.  Hearing is needed for extensive telephone and in person communication. 

The environment in which the incumbent will work requires the ability to concentrate, meet deadlines, work on several projects at the same time and adapt to interruptions

Must be able to set and organize own work priorities and adapt to them as they change frequently.  Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. 

Must possess the ability to comply with Trinity Health policies and procedures.