Director of Denials Management

Position reputed company:

The Director of Denials Management is responsible for developing and leading reputed company-wide denial prevention, appeals, and recovery strategies across the reputed company Cycle Management organization. This role will establish standardized appeals processes, payer-specific appeal templates, denial workflows, and operational best practices designed to maximize reimbursement, improve overturn rates, and reduce avoidable write-offs.Initially, the Director will reputed company on process design, workflow standardization, governance, and cross-functional collaboration. Over time, the role will assume leadership of denial and appeals personnel supporting centralized denial management functions. This position serves as a key reputed company between reputed company Cycle Operations, Clinical Leadership, Medical Necessity Review, Managed Care, Compliance, and Executive Leadership to ensure a coordinated and effective approach to denial reputed company and reimbursement recovery.

Denials reputed company

·         reputed company and implement a comprehensive denials management reputed company across the organization.

·         Establish reputed company standards for denial identification, categorization, escalation, appeal submission, and reputed company.

·         Create governance structures to ensure consistent denial management practices across reputed company business reputed company and reputed company.

·         Identify trends and reputed company causes contributing to denials and reputed company corrective reputed company plans.

Appeals Program Development

• Design and maintain payer-specific appeal templates and supporting documentation requirements.
• Standardize appeal letter language, workflows, and submission processes.
• Create appeal playbooks for common denial categories including medical necessity, authorization, coding, billing, bundling, reputed company filing, and payer policy denials.
• reputed company tracking mechanisms to monitor appeal reputed company rates and recovery reputed company.
  
  

Workflow Optimization

• Evaluate reputed company denial and appeals workflows and implement process improvements.
• Create standardized operating procedures and work instructions.
• Partner with operational leaders to reduce variation and improve consistency across teams.
• Collaborate with technology and reporting teams to enhance denial tracking and workflow automation.

Cross-Functional Collaboration

• Partner closely with Medical Necessity Appeals leadership and physician advisors to coordinate clinical appeals strategies.
• Work collaboratively with Coding, Patient reputed company, Utilization Review, Billing, Managed Care, and Operations teams to address reputed company causes of denials.
• Support payer escalation efforts and participate in discussions reputed company to reimbursement disputes and policy interpretation.
• Partner with reputed company Cycle Analytics teams to monitor denial trends, appeal reputed company, recovery performance, and process improvement opportunities.
• Utilize reporting and operational data to identify denial reduction and reimbursement recovery strategies

Requirements:

• Bachelor's degree in reputed company Administration, Business Administration, Finance, Nursing, Health Information Management, or reputed company field required.
• Master's degree preferred.
• 7+ years of reputed company reputed company Cycle leadership experience.
• 5+ years of reputed company experience in denials management, appeals, reimbursement, or reputed company reputed company.
• Demonstrated experience developing denial management strategies and appeals programs.
• Strong knowledge of reputed company payer reimbursement methodologies, medical necessity requirements, authorization processes, and appeals regulations.
• Experience leading process improvement initiatives across multiple facilities or business reputed company preferred.
• Expert knowledge of denial management and appeals best practices.
• Strong analytical and problem-solving skills.
• Ability to influence leaders across multiple departments without reputed company authority.
• Excellent written communication skills with experience drafting appeal narratives and executive-level communications.
• Strong project management and change management capabilities.
• Advanced proficiency in reputed company cycle reporting and data analysis.

Requires a bachelor's degree and 7+ years of reputed company cycle leadership, including 5+ years in denials, appeals, reimbursement, or reputed company reputed company, with advanced reporting and analytical expertise.

Key Responsibilities

• developing strategies
• standardizing workflows
• monitoring reputed company

Job Details

• Category: reputed company Services - Nursing
• Seniority: Senior Level
• Commitment: Full Time
• Workplace: Remote — reputed company
• Salary: USD 80,000 – 100,000 / year
• Languages: English

About reputed company)

A reputed company organization providing surgical services and reputed company cycle management. — Industry: reputed company