Denials Management Director

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

• Provides strategic leadership for denial management operations across the system

• Develops and implements policies, procedures, and performance standards for denial investigation and appeals

• Oversees denial trend analysis and implements prevention strategies

• Manages payer relationships and escalates complex denial issues as appropriate

• Ensures compliance with all regulatory requirements and accreditation standards

• Develops and monitors key performance indicators for denial management

• Leads, mentors, and develops denial management staff across multiple teams

• Collaborates with revenue cycle leadership on strategic initiatives and process improvements

• Prepares and presents reports on denial performance to executive leadership

• Manages departmental budget and resource allocation

• Partners with IT and analytics teams to optimize denial management systems and reporting

• Performs other duties as assigned

• Comprehensive understanding of revenue cycle processes including charge capture, billing, and reimbursement [Required]

• Extensive knowledge of CPT, HCPCS, ICD coding systems, and billing regulations for government and commercial payers [Required]

• Expert knowledge of payer policies, denial processes, and appeal strategies [Required]

• Strong leadership skills with ability to develop and manage high-performing teams [Required]

• Excellent analytical skills with ability to interpret complex data and drive strategic decisions [Required]

• Strong written and verbal communication skills with ability to present to executive leadership [Required]

• Proficiency in Microsoft Suite applications and healthcare information systems [Required]

• Ability to build collaborative relationships across organizational boundaries [Required]

• Knowledge of healthcare compliance and regulatory requirements [Required]

• Proficiency with Epic EHR system [Preferred]

• Experience with Six Sigma, Lean, or other process improvement methodologies [Preferred]

• Experience with payer contract negotiations related to denials [Preferred]

• Experience with denial management technology platforms and analytics tools [Preferred]

• Bachelor's [Required]

• Master's [Preferred]

• in finance, accounting or healthcare administrative field

• 5+ years of progressive leadership experience in healthcare revenue cycle operations, patient financial services, patient access management, or related healthcare financial operations [Required]

• 8+ years of progressive leadership experience in healthcare receivables, patient financial services, or revenue cycle operations within a complex healthcare environment. [Preferred]

• An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:

• Bachelor's Degree AND 5+ years of related work experience [Required] OR

• Associate's Degree AND 7+ years of related work experience [Required] OR

• 9+ years of related work experience [Required]

• Healthcare Financial Management Association (HFMA) [Preferred]

• Certified Revenue Cycle Rep (CRCR) [Preferred]

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.