Manager of Clinical Denials

Lake Success, NY 11042

Department: Registered Nurse (RN) Job Number: 6254 Pay Rate: $130000-160000 Employment Type: Full Time

Job Description

Our client, an organization focused on hospital reimbursement, is hiring a Manager of Clinical Denials Recovery Management.

Job Responsibilities:  
  • Management and coordination of the Clinical Denials Process.
  • Assisting in the overall planning, organization, and direction of the daily work assignments for the preparation of Clinical Appeals based upon evidence-based criteria documented within the medical record.
  • Conducts analysis on Clinical Denials and Appeals, identifying and presenting both Documentation Improvement and Revenue Protection opportunities.
  • Serve as a subject matter expert while staying up to date on clinical regulations affecting Denial Prevention and Management practice.
  • Provide Orientation, Training and Education to Clinical Denials and Appeals staff.
  • Manage a team of 16. Oversee workflow and productivity. Work with client relationships.
  • Manages and prioritizes timely review, investigation and response to Clinical Denials and the required actions for appeals within contractual timeframes.
  • Identify, monitors, and presents monthly denial performance trends utilizing case Identifies potential risk for loss reimbursement related to medical policies and prior authorization requirements.
  • Create and analysis reports
  • Maintaining and developing relationships with clients.
  • Ability to expand current scope of work with clients or add to client base by expanding work into other hospital affiliates.
  • Ability to work with other service lines within the company, for example outpatient recovery to provide enhanced revenue opportunity to clients.
  • Coordinate reports and materials and participate in quarterly status meetings with clients.
  • Involvement in NY HFMA
Job Requirements: 
  • Bachelor’s Degree or other Clinical Practice field
  • 5+ years’ experience including 5 years in Denial Management, Case Management, or related experience and 3 years of current experience with reimbursement methodologies
  • Ability to work collaboratively in a team environment
  • Ability to handle multiple assignments and carry out work independently with minimal supervision
Job Perks:  
  • Competitive salary, great benefits, and other attractive incentives
  • Generous PTO 
  • All major insurances (health, life, disability) 
  • Work-life balance is valued  
  • A team environment that believes in employee development, professional growth, and company longevity
  • Culture is one of mutual respect, teamwork, and equality
  • The organization embraces and values an inclusive work environment
Salary: The posted salary range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.

If you are passionate about what you could accomplish in this role, we would love to hear from you! 

Meet Your Recruiter

Fran Philips
Vice President, Healthcare Recruitment

Fran is a seasoned recruiter who joined Tal in 2008, after a long career in medical billing for multi-specialty practices including dermatology, dental, and ophthalmology. 

Learn more about Fran, Tal Healthcare Employee Biography

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