Director Clinical and DRG Denials

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Director Clinical and DRG Denials

Larkin Bldg @ Exchange Street

Full Time

Days

Job Description

The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue Cycle department.

Directs performance improvement initiatives, develops and maintains operational policies for the department and assures regulatory compliance is a priority.

Specifically, develops strategies and tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development and implementation of policies and procedures.

The Director, Clinical & DRG Denials will work collaboratively with physicians, nursing staff, Quality, Finance and others to develop, implement and maintain strategies that capitalize on facility and industry best practices to achieve targeted outcomes.

Identifies, communicates and holds staff accountable for performance expectations; monitors / appraises the job results / performance and promotes a positive, team-oriented work environment.

Develops relationships and influences payer policies and procedures as well as facilitating strong working relationships between HIM, Clinical Documentation, UR, Physician Advisor operations, PFS, Contracting, and hospital departments and leadership to promote effective clinical validation improvement and clinical denial management system-wide.

Significant influence on system quality and financial outcomes.

Buffalo, NY

Minimum or Preferred Qualifications

BA or BS in health related field required. MHA or MBA preferred. 10 years of experience in a healthcare environment required.

8 years of experience with Insurance Carriers, Payer policy trends and Revenue Cycle management concepts required. 5 years of experience in a large, complex acute care setting in a supervisory / administrative role required.

5 years of experience with Basic computer skills including Microsoft word, Microsoft excel with spreadsheet development and utilization, Microsoft outlook required.

8 years of experience in a multi- hospital system and / or managed care required. 10 years of experience with Federal, state and accreditation guidelines.

financial principals, reimbursement methodologies, coverage issues, documentation, coding conventions and insurance / managed care practices including but not limited to : utilization review, RAC, MAC, Q10, clinical and DRG denial management required.

Reg Health Info Tech (RHIT) required upon hire. RHIA, CDAM, CCS preferred.

Salary Range

$95,503-$149,366 annually *Wage will be determined based on factors such as candidate's experience, qualifications, internal equity, and any applicable collective bargaining agreement.*

Department

24068 - Clinical Revenue Cycle Admin

Grade

Bi-Weekly Hours

Scheduled Work Hours

8a-5p

Weekend / Holiday Requirement

No Weekends or Holidays Required

Union Code

00 - Non Union

Recruiter

Casey Calandra

Auto req ID

72111BR

Director Clinical and DRG Denials Kaleida Health