Manager - Denial Prevention
Company: Hospital Corporation of America
Location: Las Vegas, Nevada
Posted: October 13, 2017
Reference ID: 01541-15062
Serving the community for nearly 60 years, Sunrise Hospital & Medical Center provides Las Vegas and the Southwest region with high quality, advanced healthcare services. Sunrise Hospital is the largest acute care facility in Nevada. Sharing the same campus as Sunrise Children's Hospital, Nevada's largest most comprehensive children's hospital.
Responsible for providing direction and oversight of concurrent denial prevention initiatives within the assigned facility. Maintains a current working knowledge of non-governmental and governmental payers and contracted language. Knowledge of payer trends and analysis of denials with a focus on prevention of denials within the acute setting. Will assist with the identification of strategies for prevention and initiate processes for denial avoidance. Monitors and provides detailed analysis of trends in the non-governmental sector. Provides direction and support to the assigned facility with root cause analysis of received denials. Develops and implements action plans with interventions as needed with all facility departments. Identifies education opportunities within the facility and assists with communication required for intervention. Provides updates to developed reports/dashboards and communicates weekly with Division Denial Prevention Manager and facility CFO on all opportunities and daily to the facility Administrative Director of Case Management. Responsible for immediate interventions to assist facility in prevention of denials. Communicates appropriately with all relevant entities: Facility, Division, SSC, PDU, Managed Care AVPs and Payers.
SUPERVISION: CFO/Director of Case Management/Division Director of Denials Prevention
Employees reporting to:
Budget responsible for: N/A
Minimum job criteria including educational requirements, licensure, registration, certification and equivalencies, and work experience. All education and degrees must be from an accredited institution.
Education: College Degree/ Bachelor's Degree Preferred/BSN Preferred
License or certifications:
Current RN Licensure in Nevada, CCM Preferred
Clinical Documentation Improvement experience preferred. Denial/Appeal Management experience required in Commercial or Managed Care arena. Analytical skill set necessary. Excellent oral and written / interpersonal
communication skills and Customer Service oriented.
• Minimum 5 years as Acute Care Case Manager
• Knowledge of accreditation standards and compliance requirements
• Knowledge of government and non-government payer practice regulation standards and reimbursement.
• Minimum 1 year experience as Facility Denials Prevention Lead.
Basic computer skills with working knowledge of Microsoft Office, word-processing and excel spreadsheet
Software, MIDAS, Meditech, Artiva, On-Base