Director of Clinical Denials Management (RN)
New York Metro Area, NY
Title: Senior Director of Clinical Denials Management (RN)
Location: New York Metro Area
Occupational Category: Nurse
Description: Hiring a Senior Director of Clinical Denials Management for a leading academic medical center in New York Metro Are. The Senior Director of Clinical Denials Management provides strategic vision and direction for the Clinical Denials Management program.
- Leads process improvement initiatives to prevent denials.
- Facilitate monthly denial meetings and communicate denial trends to Leadership, Case Management, and Physician Advisors.
- Monitor and track clinical denials and appeals workflow to ensure timely submission of required appeals.
- Evaluate potentially avoidable utilization trends within departments.
- Recruit, on-board, train, and evaluate employees.
- Develop and maintain productivity standards for areas of direct responsibility and monitors adherence to those standards.
- RN with bachelor's degree required; Master's degree strongly preferred.
- 3 to 5 years of progressive experience in appeal/denial management
- 3 to 5 years management experience
- 3 to 5 years of progressive experience with utilization management or care management
- Strong knowledge of health plan requirements
- Knowledge of EPIC enterprise system preferred.
- Knowledge of coding guidelines, both ICD-10 and CPT is preferred.
- CCS Preferred.
- Knowledge of federal, regional and state payer coverage patterns (CMS, fiscal intermediary, and Administrative Law Judge).
- Excellent communication and interpersonal skills.
- Strong analytical and statistical analysis skills required
- Microsoft Excel, Word and PowerPoint skills required.