RN, Director of Denials Management

Smith Arnold Partners

Our client, an academic acute care medical center, is looking for a RN, Director of Denials Management for their expanding department. The RN, Director of Denials Management will provide strategic vision and direction for the Denials Management program. The RN, Director of Denials Management will lead process improvement initiatives to prevent denials.

Position: RN, Director of Denials Management
Location: Tarrytown, NY
Salary: $150,000.00

Responsibilities:

•Works collaboratively with leadership, medical staff, inter-disciplinary team members and revenue cycle entities to ensure optimal reimbursement and regulatory compliance
•Monitors and tracks clinical denials and appeals workflow to ensure timely submission of required appeals. Ensures timely submission of KPIs. Validates KPIs and triggers process improvement efforts pro-actively based on performance targets
•Collaborates with inter-disciplinary team to evaluate potentially avoidable utilization trends within departments
•Hires, orients, trains, conducts performance evaluations, handles corrective actions, and provide an open and goal oriented work environment with established clear and concise work procedures and productivity standards

Requirements:

•Must have a NYS RN License
•Three (3) to Five (5) years of experience in appeals/denials management a MUST
•Three (3) to Five (5) years of experience with utilization management or care management a MUST
•Knowledge of federal, regional and state payer coverage patterns (CMS, fiscal intermediary, and Administrative Law Judge)
•Strong knowledge of health plan requirements

Application