Revenue Cycle Manager - Denials Prevention

Stamford Health is committed to preventing the spread of infectious diseases and cares about your health and the health of our employees. To that end, if you are invited to interview in one of our offices/campuses, and you or a member of your family and/or significant other is experiencing symptoms (i.e. fever, coughing or other respiratory symptoms), or you simply don’t feel well, please inform the HR Representative immediately so we may schedule your interview for a later date. When arriving on our campus or site whether for an interview or to begin your employment with us, please note it is imperative you abide by CT State Guidelines on Travel Advisory which can be found here https://portal.ct.gov/Coronavirus/Travel. Please schedule accordingly and update your HR Representative immediately to make any necessary arrangements/adjustments to scheduling.

About Stamford Health

Stamford Health is a non-profit independent healthcare system with more than 3,500 employees committed to compassionately caring for the community and offering a wide-range of high-quality health and wellness services. Patients and their families can rely on comprehensive person-centered care through the system’s 305-bed Stamford Hospital; Stamford Health Medical Group, with more than 30 offices in lower Fairfield County offering primary and specialty care; a growing number of ambulatory locations across the region; and support through the Stamford Hospital Foundation. Stamford Health is also a major teaching affiliate of the Columbia University College of Physicians and Surgeons. Dedicated to being the community’s most trusted healthcare partner, Stamford Health puts patients first to build long-lasting relationships. For more information, visit StamfordHealth.org. Like us on Facebook and follow us on Twitter, YouTube, and Linked In.

JOB SUMMARY:

A system-level position accountable for oversight of the Denial Prevention Committee (DPC) and for conducting analysis of denials and denial trends by type, area of responsibility, payer, etc. Responsible for the coordination of the appeals process for clinical and administrative denials as identified by senior leadership. The Denials Prevention Manager works with Revenue Cycle senior leadership, Reimbursement/Managed Care, and Finance executive leadership to champion the denials prevention process. The incumbent will co-chair the DPC to ensure key stakeholders from Pre-Service, Point of Service, HIM/Coding, UR/CM, Patient Accounts/CBO, and specific ambulatory areas are accountable for denials reduction performance as a part of an overall prevention/avoidance strategy.

Key Responsibilities:

• Leads monthly denials prevention committee and participates in subgroup meetings related to denial prevention.
• Central point of contact for denials questions, reports, dashboards, and data distribution.
• Rounds monthly to meet with key stakeholders to discuss the ‘story’ behind the data and champions behavior change.
• Monitors initial denial rate, final write-offs, and overturn rate as key metrics for success.
• Works closely with UR team and Physician Advisor to address clinical denials.
• Oversees the regular occurring denials management committee and appropriately coordinates and involves key accountable stakeholders in a collaborative manner from Pre-Service, Point of Service, HIM/Coding, UR/CM, Patient Accounts and specific ambulatory areas, Finance and Managed Care. Provides ongoing denial management updates at the monthly RCM meeting.
• Acts as the “super user” of the denials prevention system and for denials reporting. Provides key input and participation on any system upgrades or enhancements affecting these systems.
• Develops a familiarity with the contract management structure across Stamford Health to understand the payment variance process and how tools/programming interfaces with the system’s two EMRs.
• Performs analysis and “data mining” of denials information using analytical tools (e.g., Excel, Access) and available reporting in Tableau.
• Appropriately involves the Executive Director of Revenue Cycle to ensure accountability occurs across key stakeholder areas. Appropriately raises issues and challenges so that these individuals can help champion denial prevention initiative across the enterprise.
• Interfaces with Patient Accounting and Pre-Service & Point of Service areas (or other areas as denials are identified) to ensure timely reporting and follow-up of problems or denials.
• Provides trends on denial patterns by payer to Finance, Revenue Cycle Leadership and Managed Care Contracting.
• Appropriately utilizes industry information (e.g., from HFMA, AAHAM, etc.) and peer resources (e.g., State Hospital Association) to understand national and regional denial trends, peer hospital innovations and successes relating to denial prevention.

QUALIFICATIONS/REQUIREMENTS:

• Bachelor’s degree required. Master’s degree in Business Administration, Healthcare Administration or relevant equivalent desirable.
• At least five years of broad Revenue Cycle experience required.
• Deep denial prevention experience preferred.
• Experience with CMS, large commercial payers, denial rules and denial behaviors a plus.
• Professional certification desirable (AAHAM, HFMA).
• Ability to support the Executive Director of Revenue Cycle, Finance/Reimbursement and the CFO with key reporting and trending relating to the denial management process.
• Demonstrated advanced proficiency in desktop computer programs such as Microsoft Excel, PowerPoint, Word, Outlook, and an ability to conduct data mining and broad denials research.
• Familiarity with patient accounting systems and related business office adjunct systems (Tableau, etc.).
• Demonstrated knowledge of managed care payer requirements in acute and ambulatory settings.
• Experience with denial workflows and work queue management.
• Demonstrated ability to facilitate team or group activities and demonstrated leadership qualities including professional verbal and written communication skills.
• Demonstrated ability to be flexible and to prioritize workload, decision-making skills, and professional development through participation in continuing education and professional organizations.
• Ability to train staff on new technologies and processes, and to analyze workflow for process improvement.

• We are committed to building an inclusive workplace that values diversity and inclusion and reflects the diversity of the community and patients we serve.

EXPERIENCE: At least five years of broad Revenue Cycle experience required. Deep denial prevention experience preferred. Experience with CMS, large commercial payers, denial rules and denial behaviors a plus. Professional certification desirable (AAHAM, HFMA).

EDUCATION: Bachelor’s degree required. Master’s degree in Business Administration, Healthcare Administration or relevant equivalent desirable.