nThrive

Director, Denials Operations

Job ID
2017-20920
Employment Type
full-time
Saddle River
Hours Per Week
0.00
NJ

Overview

The Denial Operations Director serves as within the Managed Care Services team. The Director is responsible for overseeing the day-to-day operations of the denials management and recovery services for team. The Director is responsible for achieving revenue goals, productivity and operational metrics internally and externally including Client retention and satisfaction. The Director engages in proactive and ongoing communication within Denials and Payment Variance and with cross-functional teams to ensure proactive communication, addressing issues, escalating perceived or identified issues and to ensure internal and external client satisfaction. The director is responsible for setting performance expectations and engaging team members to meet defined goals and objectives in coordination with the Senior Director.

Responsibilities

  • Oversee the day-to-day operations the centralized denial teams.
  • Responsible for no less than 3 direct reports and approximately 50 FTEs.
  • Monitor team productivity, quality and revenue performance.
  • Foster and maintain a positive and engaging workplace environment.
  • Ensure timely and appropriate response to clinical and technical claim denials; ensure maximized claim denial recovery for all clients.
  • Responsible for gathering and reporting revenue information monthly or as needed.       Participate in revenue projection reviews.
  • 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.
  • Review all client report packages to ensure accuracy and listing of performance call-outs during internal and external client meetings.
  • Work closely with Client Enablement to ensure accurate reporting of individual client performance and other reporting packages.
  • Work closely with all cross-functional teams to ensure accurate reporting of individual clients.
  • Actively participate in client implementations for outsourced denial management and recovery services to ensure optimal service delivery and implementation success.
  • Define in coordination with the Senior Director denial team performance expectations
  • Facilitate departmental team members and actively participate in business excellence initiatives.
  • Participate, as needed, in client implementations for denial services.
  • Responsible for new hire training and team training and development, including all materials and maintenance of organizational and client specific resource and educational materials.
  • Enforce organizational and company policy.
  • Other duties as assigned.

Qualifications

  • Minimum of 5 years’ experience in hospital revenue cycle environments
  • Minimum of 2 years’ experience leading service delivery teams in a director or manager capacity.

Preferred Skills

  • Bachelor’s degree from a four-year college or university is preferred.
  • 3 years’ experience in post payment review, denials, billing, and collection activities preferred.

About nThrive

nThrive is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations

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