Position Summary

The Denial Management Supervisor role belongs to the Revenue Cycle department and is responsible for overseeing and managing the day-to-day operations of the denial management team. This role ensures the efficient and timely resolution of complex third-party insurance denials and outstanding claims, aiming to optimize revenue recovery and minimize financial losses. The supervisor leads a team of denial management specialists, providing guidance, training, coaching, and establishing clear workflows. In addition to team management, the Denial Management Supervisor analyzes key performance metrics, prepares detailed reports regarding denial trends, actionable insights, and implements strategies to reduce future denials. The supervisor establishes clear workflows, enforces adherence to policies and payor guidelines, and ensures compliance with regulatory requirements. This position reports to the Patient Financial Engagement Manager and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, and practice staff. 

Key Responsibilities

• Oversee daily operations of the denial management team, ensuring workloads are balanced and tasks are completed efficiently.
• Train and mentor staff, providing regular feedback and performance evaluations.
• Foster a positive, collaborative and high-performing team environment.
• Monitor and manage resolution of denied claims to ensure timely to ensure timely and accurately processing of appeals.
• Establish and enforce workflows, policies, and procedures for denial management.
• Track key performance indicators (KPIs) such as denial rates, resolution timeliness, and team productivity.
• Analyze denial trends and prepare detailed Excel reports for management identifying areas of improvement.
• Implement strategies to reduce future denials and enhance revenue recovery processes.
• Ensure compliance with payer guidelines, state and federal regulations, and organizational policies.
• Conduct quality checks on claim reword and denial follow-up processes to maintain high standards.
• Lead initiatives to streamline processes, improve efficiency, and enhance team capabilities.
• Experience in payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment. 
• Requires extensive knowledge of carrier specific claim appeal guidelines. Conducts comprehensive reviews of the claim denial and makes determinations if an authorization needs to be obtained, a written appeal is needed, or if no action is needed.
• Writes professionally written detailed appeals which include compelling arguments based on clinical documentation, third-party medical policies, and contract language.
• Customize appeals to payers in accordance with Medicare, and third-party guidelines as well as VitalConnect policies and procedures.
• Possesses proven analytical and decision-making skills to determine what selective clinical information must be submitted to properly appeal the denial.
• Train team on contacting payers, via website, payer portal, phone and/or correspondence, regarding reimbursement of claims.
• Understands medical billing requirements for Medicare, Medicaid, contracted, in-network, out of network and commercial payers.
• Strong understanding of insurance plans (HMO, PPO, IPO, etc.), explanation of benefits (EOBs), remittance and remark codes, coordination of benefits, medical terminology, limited coverage and utilization guidelines, denial remark codes and timely filing guidelines.
• Responsible for tracking and trending of recovery efforts by utilizing various departmental tools and appropriately reporting on-going problems specific to payers and/or contracts.
• Ensure team is meeting the current productivity standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and accurately document the patient account.

• Escalate exhausted accounts that will not be financially cleared as outlined by department policy to management.
• Maintains confidentiality of patient's financial and medical records, adheres to the State and Federal laws regulating collections in healthcare; adheres to HIPAA compliance, enterprise and other regulatory confidentiality policies, and advises management of any potential compliance issues immediately. 
• Perform other related duties as assigned or required.

Qualifications

• Requires a minimum of 5 years of experience in denial management, or a strong background in a medical collections setting with experience in denials, appeals, insurance collections and related follow-up is preferred.
• High school diploma or GED required; additional coursework in healthcare administration is preferred.
• Proficient with EHR/billing software and Microsoft Office Suite applications, specifically Excel and Word.

• Exhibits strong leadership, communication and analytical skills.
• Ability to effectively handle challenging situations and to balance multiple priorities.
• Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.
• Must be able to maintain strict confidentiality of all personal/health sensitive information.
• Ability to work independently and manage a remote team effectively

 

The estimated hiring salary range for this position is $65,000 to &75,000.^* The actual salary will be based on a variety of job-related factors, including geography, skills, education and experience. The range is a good faith estimate and may be modified in the future. This role is also eligible for a range of benefits including medical, dental and 401Kretirement plan.