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Manager Revenue Cycle Denials & Appeals (Commercial Payers) -PFS Account Resolution - Remote

Company: WellStar Health System
Location: Marietta
Posted on: May 28, 2023

Job Description:

OverviewHow would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.ResponsibilitiesThis position is remote - Work From HomeUnder the direction of the Director of HB A/R Management, the Manager RC of Denials and Appeals coordinates all assigned HBDenials and technical appeals department activities including, but not limited to supervising, training, interviewing, hiring,counseling and terminating employees, as circumstances dictate. The Manager of Denials and Appeals must provide thedynamic development of strategies for establishing a continuous improvement work environment, open and closed technicaldenial accounts are reviewed, corrected, escalated, or closed within the designated payer time frames and are documentedappropriately in the patient accounting system. The role requires extensive data analysis, trending analysis, projectmanagement, and departmental educational capabilities regarding payor and revenue cycle payment related processes.This role requires a versatile and well developed knowledge of billing, collections, technical denials appeal/correction process,and understanding of provider/payor escalation requirements. In addition to a strong understanding and capability of commonbusiness technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessmentand analysis of multiple acute care and LTAC facility accounts receivable portfolios. The core role focus of this position is toensure that open and closed technical denial accounts are brought final resolution through reimbursement for services and tomitigate financial losses through solid operational execution, development and conformity to defined Policies and Procedures.The Manager must possess the ability to develop and document action plans for quick resource deployment and communicatetimely with staff to understand the specific reasons for on going open technical denial trends. The role requires the ability toeffectively and efficiently communicate both orally and in writing to Senior Leadership, multi-task, meet deadlines, enforceorganizational policies and procedures, maintain high staff engagement, ensure staff productivity, appropriate cost controls andproduce effective operational execution. In addition, the Manager will assist with additional Revenue Cycle related tasks andduties as assigned.QualificationsRequired Minimum Education:Bachelor's degree in business, healthcare, related field or ten years commensurate experience is required.Required Minimum Experience:Three (3) to Five (5) years experience hospital healthcare preferred, claims processing management, collections or othermanagement, or other management role in a healthcare environment.Required Minimum Skills:1. Establish a climate to achieve optimal performance levels and maintain a cohesive work team2. Demonstrate proficiency in reading UB043. Demonstrate knowledge and proficiency Payor Appeal submission (technical)4. Demonstrate knowledge of billing rules and coverage for all major payors5. Identify where to locate and review state and federal regulations as they relate to all payers6. Access Major payer(s) specific provider websites for claim investigation, correction and resolution pathdetermination7. Identify technical denial trends effecting the revenue cycle and escalate for needed solution8. Analyze all technical denials effecting the revenue cycle9. Create and studies revenue reports/Key Performance Indicators and makes recommendations relative to revenuecycle processes for optimization10. Follow standard escalation process in established time frames11. Demonstrate knowledge and proficiency of claims resolution12. Review staff productivity report on a weekly basis and identify areas of opportunity13. Post adjustments at time of account review14. Create/update department policies and procedures15. Access Major payer(s) specific provider websites for claim investigation, correction and resolution pathdetermination16. Work efficiently under pressure and deal effectively with constant change17. Operate a computer and related applications18. Apply appropriate supervisory, management and leadership techniques in an operational setting19. Work independently and take initiative20. Demonstrate a commitment to continuous learning21. Willingly accept responsibility and/or delegate responsibilityWe'd like to invite you on a career journey like no other! In return for your contributions, we'll help you make the most of all life's moments - on and off the job. Wellstar Total Rewards is designed to provide for your total well-being, including: -Your Wellness, -Your Pay, -Your Future, -Your Joy. - We think it's pretty simple - we care for our team members and our team members care for the community. Make a difference in patients' lives--- and your own! Here, it's more than healthcare - it's CareerCare!

Keywords: WellStar Health System, Marietta , Manager Revenue Cycle Denials & Appeals (Commercial Payers) -PFS Account Resolution - Remote, Executive , Marietta, Georgia

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