Director of Clinical Denials Management,MD or FMG

Academic acute care medical center, is looking for a MD or FMG, Director of Clinical Denials Management for their expanding department. The MD or FMG, Director of Clinical Denials Management will provide strategic vision and direction for the Clinical Denials Management program. The RN or FMG, Director of Clinical Denials Management will lead process improvement initiatives to prevent denials.

Position: Director of Clinical Denials Management MD or FMG
Location: Tarrytown, NY
Salary: $130,000+

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 be a MD or FMG
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