nThrive

Director, Clinical Denials

Job ID
2017-20919
Employment Type
full-time
Saddle River
Hours Per Week
0.00
NJ

Overview

The Denial Clinical Director serves as one of the subject matter experts for clinical denials within the Managed Care Services team. The Director is jointly responsible for client interfacing activities including preparing metric presentation materials. The Director is responsible for achieving revenue goals, productivity and operational metrics internally and externally including Client retention and satisfaction. The Director will participate in client denial task force meetings for assigned clients. The Director shall in coordination with the Sr. Director of Managed Care Services define/prepare clinical team educational materials and will establish clinical appeal team performance expectations including ensuring the clinical performance goals are achieved.

Responsibilities

  • Client Retention and client satisfaction
  • Meeting internal and external revenue goals, productivity goals and performance metrics
  • Responsible for the day to day operations of the centralized clinical denials team
  • Serve as the clinical point of contact for all assigned clients.
  • Serve as one of the organizational subject matter expert for clinical denials.
  • Participate in denial task force meetings for the purpose of denial education of denial inventory, appeals, recoveries thereof, and opportunities for improvement.
  • Proactively communicate to senior management identified issues, potential issues and risks with internal and external client perception, client satisfaction, and all levels of performance.
  • Work closely with the Senior Director of Denials and other management to ensure internal and external client issues or potential issues are escalated timely.
  • Review all client report packages to ensure accuracy and listing of performance call-outs during internal and external client meetings.
  • Ensure timely and appropriate response to clinical and technical claim denials; ensure maximized claim denial recovery for all clients.
  • Ensure operational compliance with client scope of work (SOW) agreements. Ensure compliance with in-scope vs. out-of-scope provisions of the SOW or implementation process.
  • Work closely with all cross-functional teams to ensure accurate reporting of individual clients.
  • Analyze and report denial trends to internal and external client and organizational leaders.
  • Foster and maintain a positive and engaging workplace environment.
  • Monitor appeal turn-around-times; work with senior management and cross-functional teams to drive performance ensure internal/external client expectations are met/exceeded.
  • Participate, as needed, in client implementations for denial services as assigned
  • Create clinical training materials and work with nThrive education to ensure delivery to clinical team.
  • Define in coordination with the Senior Director clinical team performance expectations
  • Facilitate departmental team members and actively participate in business excellence initiatives.
  • Facilitate departmental team meetings, as needed, and actively participate in business excellence initiatives as assigned.
  • Responsible for new hire training and team training and development.
  • Enforce organizational and company policy.
  • Travel to/from client locations required as defined as assigned
  • Other duties as assigned.

Qualifications

  • Minimum of 5 years’ combined experience as a hospital case manager, utilization review nurse/manager, clinical denial department director, or as a federal/state auditor
  • Minimum of 3 years’ experience leading clinical denial recovery teams/efforts preferred.
  • Comprehensive knowledge of the Revenue Cycle
  • RN preferred

Preferred Skills

  • BSN or master’s degree from a four-year college or university is preferred.
  • 2 years’ experience in hospital based case/care management or utilization management.

About nThrive

nThrive is the leader in providing end-to-end revenue cycle services, technology and education solutions. Previously known as MedAssets, Precyse and Equation, each formerly a leader in its own right, we’ve combined our talents and capabilities into a single enterprise. At nThrive, we are people who are passionate about empowering health care for every one in every community. We work together to transform financial and operational performance, enabling health care organizations to thrive.   nThrive is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.

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