Description

The Denial Prevention Manager (DPM) will lead a team of denial prevention specialists (DPS) to streamline and optimize the denial management process within CND. This involves leading the team to identify, analyze, and resolve denied claims to ensure timely reimbursement and improve overall revenue cycle performance. The DPM spearheads achieving and maintaining compliance with federal and state regulations through rigorous oversight of coding practices using ICD-10, CPT, and HCPCS coding systems, ensuring accurate clean claims submission and maximizing reimbursement. The DPM will actively identify and rectify coding discrepancies and errors to ensure compliance and regulatory and internal requirements and policies. The Denial Prevention Manager will work closely with the DPS team to manage workflows and ensure timely and accurate follow-up and resolution of outstanding denials. In addition, leverage internal processes to track, trend, and analyze the root cause of denials and implement corrective actions. Review outcomes of appeals and communicate prevention strategies within CND to include, providing monthly reports of all activities by payer and other change strategies. Collaborate with other CND departments to resolve identified opportunities through coding, training, and process changes.

Job Responsibilities:

Implement strategies to prevent claim denials at the source, focusing on areas like referral, pre-authorization, eligibility, and coding accuracy.
Manage and audit medical coding practices for accuracy and compliance with ICD-10-CM, AHA Coding Clinic, AMA CPT, and Lifepoint HSC guidelines.
Research and analyze payer denials across various revenue cycle stages.
Compose clear and compelling appeals based on medical record reviews and relevant Medicare, Medicaid, third party and CND guidelines maximizing timely reimbursement recovery.This includes submitting retro-authorizations in accordance with payor requirements in response to authorization denials.
Provide expert guidance on complex coding issues and support the Billing staff with resolving coding-related queries.
Conduct regular audits of coding practices to identify and correct discrepancies, and implement corrective action plans as needed.
Collaborate with Billing, Clinical Services, Market Access, and Patient Access to optimize denial prevention strategies and enhance overall revenue cycle efficiency.
Identify denial trends and proactively educate staff on best practices to minimize future denials.
Manage outstanding AR related to denials.
Manage denial-related outstanding accounts receivable (AR) to ensure timely and accurate claim resolution.
Process and track correspondences and medical record requests following department workflow procedures to ensure timely and accurate responses.
Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
Complete special projects as assigned
Adhere to industry coding standards (ICD-10-CM, etc.) and ethical coding practices (AHIMA), as well as Lifepoint Health Support Center (HSC) policies and procedures.
Knowledge, Skills & Experience:

Minimum of 5 years of experience in medical billing and denial management, with at least 3 years in a supervisory or management role preferably in a diagnostic laboratory setting.
Demonstrated knowledge of all insurance companies, HMO's, PPO's, Medicare, and other third-party payers.
Experience with Salesforce, Waystar, Trizetto, and Quadax is a plus
In-depth knowledge of ICD-10, CPT, HCPCS coding systems and medical terminology.
Strong understanding of healthcare regulations, including HIPAA, CMS, and OIG guidelines.
Knowledge of business processes, accounting principles, billing practices, medical terms, billing software and electronic health records (EHR) Systems.
Detail-oriented with excellent time management and multitasking skills.
Knowledge of Medicare, Medicaid, and commercial insurance.
Must have a good working knowledge of explanation of benefits (EOB's) and comprehensive understanding of remittance and remark codes.
Requires a high level of problem solving, and analytics skills.
Effective communication and interpersonal skills
Strong skills with Microsoft office with a focus on Excel and Word.
Strong computer-based skills, specifically with Salesforce, Medisoft, Quadax, and Microsoft programs.
Education, Certifications, and Licensures:

Bachelor's degree in healthcare administration, business, finance, or related field; master's degree preferred.
Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or equivalent certification required.
Special Training:

Salesforce, Quadax, TriZetto, Waystar
Other:

This is a full-time remote opportunity for the MST time zone.
May require quarterly meetings in Scottsdale, AZ headquarters or regional office in Atlanta.

For more information, or to apply now, you must go to the website below. Please DO NOT email your resume to us as we only accept applications through our website.

https://cndlifesciences.pshire.com/jobs/1008-1560.html