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Manager of Clinical Appeals

Houston, TX · Healthcare
Manager of Clinical Appeals – Hospital Business Office
Houston, TX (NW suburb, near Spring Branch)
*** This is a Full-Time CONTRACT-TO-HIRE position  ***

 Job Summary:
  • Manage daily operations within Clinical Appeals
  • Ensures process and resource allocation is appropriate to meet business goals; keep senior leadership and others updated when there are situations that may impede business goals from being met
  • Proactively communicates updates, reports and feedback to senior leadership
  • Problem and issue identification and resolution
  • Work with all facilities, external vendors and other corporate departments to document new and existing policies, procedures and reports
  • Perform financial and procedural analysis to identify trends and problems and collaborates in the implementation of solutions
  • Interact with ministries and Clinical Appeals leadership to implement policies, procedures and systems and to gather and disseminate information
  • Proactively pursues knowledge to stay current with regards to health care compliance, denials, denial management, payor updates, regulations and contracts
  • Support the Director in the development of department, inclusive of helping to fill key positions and deploying the resources necessary to support the department
  • Assist Department in managing communicating efforts to business offices, Centralized Business Offices and other Corporate departments as well as advising them of process improvements along the revenue cycle
  • Manage the tracking and reporting project progress, providing necessary training or communications to facilities regarding operational improvements along the revenue cycle
  • Provide leadership and management of overseeing, identifying, developing and implementing tools, automation, reports and educational materials to support the interaction between the facilities, within Revenue Services, and other Corporate Departments
  • Help coordinate specific data needs and requests from and between the above-mentioned departments and facilities
  • Cultivate internal relationships at the corporate and facility level to gain support and participation in initiatives including ministries, PFS, Managed Care, Decision Support and other Corporate and ministry departments
  • Provide analysis capabilities, information and tools to operations to enhance skills in detecting both current and future performance issues
  • Any other duties or projects as may be necessary to effectively complete the duties of the position or as assigned by the Director from time to time
Preferred Background: 
  • 4 Year College Degree or equivalent hospital leadership experience required
  • Must have knowledge, or obtain knowledge within 90 days, on all major payor groups, including HMO's and PPO's, Medicare, Medicare Advantage, Medicaid and Managed Medicaid procedures for payment turnaround.
  • Excellent communication skills
  • Ability to successfully interact with associates and leaders within Revenue Cycle and other areas
  • Ability to lead cross functional teams, mentor and support the development of associates
  • Ability to report to multiple leaders
  • Must possess proven strong problem solving skills
  • Strong foundation of Revenue Cycle functions and denial management; or ability to transfer equivalent knowledge to quickly become proficient
  • Familiarity with management reporting, metrics and goal setting
  • Ability to work independently, achieve tight deadlines and take initiative on multiple projects
  • Ability to make sound decisions that are generally guided by core values, mission and policies and procedures (or) escalate when needed
  • Requires proficiency with MC Office and other healthcare systems such as EHRs, claim systems, case management systems, imaging etc.
  • Years of experience, education and work performance of an internal Associate may be reviewed and considered for possible promotion into this position if the Associate has demonstrated knowledge of denials management and third party rules and requirements 

480.269.9491 (CALL – TEXT – FAX)
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