Fraud Prevention Manager manages a team of analysts responsible for the detection, prevention, and mitigation of fraudulent transactions. Develops cross-functional initiatives to proactively detect and prevent fraud from occurring. Being a Fraud Prevention Manager approves and implements recommendations for process and procedure improvements. Reviews and implements best practices in the fraud prevention industry. Additionally, Fraud Prevention Manager ensures compliance with all relevant anti-fraud regulations and standards. Creates reports outlining trends, risks, and mitigation strategies. Requires a bachelor's degree. Typically reports to a director. The Fraud Prevention Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Fraud Prevention Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)
The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.
Want to join a team of daring managers who care without reservations or limits? Our HealthOne team is looking for a Division Denial Prevention Manager. HCA Healthcare is an advanced healthcare network that has committed up to $300 million to our incredible team members over the course of three years.
HealthOne, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
HCA Healthcare is committed to research and clinical protocols. Do you want to impact standards of care and save lives across the country? Apply today to our Denial Prevention Manager and be a part of the innovation of ideas.
The Denial Prevention Manager works in collaboration with the Division Denial Manager, primarily focusing on identifying trends and action plans to mitigate loss due to denials, governmental denials or other payer/regulatory opportunities. The Denial Prevention Manager fosters effective communications among the division, hospitals, and all disciplines. This role requires project management, analytic skills and data reporting capability to provide denial prevention strategies through use of multiple HCA databases. The Manager champions HCA’s strategy and company/division/facility initiatives to ensure short and long-term objectives are operationalized within Continental Division hospitals. The Manager will identify opportunities for improvement and facilitate process standardization to promote improved outcomes, maximize resource utilization, and improve organizational efficiencies. This position must travel to and from locations within the Continental Division geographic area less than 25% of the time.
Provides guidance to and actively participates with facility staff to identify, implement or enhance Denial reduction and NCD/LCD knowledge in collaboration with the Continental Division Denial Director and programs consistent with HCA and facility strategy
Collaborate with payer escalations to identify resolutions for policies or procedures impacting denials.
Assesses business office, revenue cycle and/or clinical opportunities that link with denial reduction, focusing on patterns of new denials and analysis of write-off opportunities.
Disseminates information accurately and timely with multiple audiences
Identifies process improvement opportunities; develops, implements, monitors, and revises action plans.
Identifies and shares best-demonstrated practices; stays abreast of current practice standards
Assist with developing, revising, and implementing HCA denial reduction or government compliance processes.
Performs quality improvement activities to ensure data integrity relative to denial reduction activities, governmental compliance, and opportunities identified through the DMAT process.
Fosters communication and facilitates collaboration between the facility Case Management, PAD, CFO, and other departments within HCA.
Facilitates ongoing education within the division for identified areas and serves as a subject matter expert.
Data analysis related to Denial Management, payer trends, etc.
Assesses learning needs relating to denial reduction and government compliance and implements appropriate educational activities to expand the knowledge base.
As part of HCA Healthcare, we at HealthONE® serve the metro Denver area as the largest healthcare system, with more than 11,000 employees. Our hospitals – The Medical Center of Aurora, North Suburban Medical Center, Presbyterian/St. Luke’s Medical Center, Rocky Mountain Hospital for Children, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center and Spalding Rehabilitation Hospital work together to provide a higher level of care. In addition, our system includes eight hospital freestanding emergency departments and numerous ambulatory surgery centers, eight CareNow urgent care centers and occupational medicine clinics, physician practices, medical imaging centers and AirLife Denver, which provides critical care air and ground transportation serving Colorado and surrounding states.
"Good people beget good people."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
Unlock your potential with a leading healthcare provider dedicated to its patients, colleagues and communities. Help guide our team as a Denial Prevention Manager and help us improve more lives in more ways.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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