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SSC- Denials & Appeals Supervisor

Company: Avidity Exchange LLC
Location: Nashville
Posted on: August 17, 2019

Job Description:

SSC- Denials & Appeals Supervisor PLEASE PROVIDE A PERSONAL EMAIL AND CONTACT PHONE NUMBER WHEN APPLYING SSC- Denials & Appeals Supervisor Nurse: Other Antioch, TN Full-time Key qualifications Licenses and certifications RN, TN License Minimum education Associates Years of experience 2+ years Overview We are looking for a talented and compassionate Denials & Appeals Supervisor to join our team. In this role you will be responsible for direct supervision of assigned Denials & Appeals Team members including monitoring productivity, quality, and attendance. Additional responsibilities include but are not limited to oversight of inventory levels, training, review of escalated accounts and participation in denials management activities. Essential Duties and Responsibilities: include the following. Other duties may be assigned. Review and monitor all high dollar appeals for accuracy and appropriateness Ensure accuracy and timeliness of all escalated appeals Complete action required for escalated account workflow pools Monitor high balance account pools to ensure acceptable inventory levels Provide department-based training and support Conduct department quality reviews Maintain training and reference material on SharePoint site Monitor BARRT and Appeal inventory and ensure compliance for completion standards Participate on facility denial calls / lead calls as needed Support department report production Supervises 15-20 coleagues 1. Competitive salary offered 2. Full benefits package available 3. Opportunity to work a flex schedule Skills for This Job: 1. Current licensure as an R.N. 2. Minimum five years clinical experience 3. Experience with acute facility revenue cycle operations preferred 4. Denial and Appeals experience 5. Supervisor and Case Management experience a plus Perks Professional development opportunities Full benefits schedule details 5 days/week Company We are one of 6 shared service centers (SSC) across the country. Each SSC supports a number of our 120 hospitals by providing revenue cycle/back office support for our assigned hospitals. This includes Billing, Collections, Refunds, Denials/Appeals, and Cash Posting (and related Cash support) activities. Our Denials/Appeals team is made up both clinical/non-clinical staff that are primarily responsible for reviewing and appealing claims. Details Summary: The Clinical Denials & Appeals Supervisor is responsible for direct supervision of assigned Denials & Appeals Team members including monitoring productivity, quality, and attendance. Additional responsibilities include but are not limited to oversight of inventory levels, training, review of escalated accounts and participation in denials management activities. Essential Duties and Responsibilities: include the following. Other duties may be assigned. Review and monitor all high dollar appeals for accuracy and appropriateness Ensure accuracy and timeliness of all escalated appeals Complete action required for escalated account workflow pools Monitor high balance account pools to ensure acceptable inventory levels Provide department-based training and support Conduct department quality reviews Maintain training and reference material on SharePoint site Monitor BARRT and Appeal inventory and ensure compliance for completion standards Participate on facility denial calls / lead calls as needed Support department report production Provide first level review and approval of adjustment transactions Review facility/payer based issues identified and maintain department issues log Lead special inventory projects as assigned Monitor productivity Approve and enter time exceptions/updates in KRONOS Monitor team attendance Provide team members with routine feedback on individual quality and productivity performance Provide coverage for coordinators and appeal specialists during vacation/leaves Perform all other duties as assigned Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Minimum five years clinical experience Hospital business office experience a plus Excellent verbal and written communication skills required Knowledge of denial and appeal processes Appeal experience preferred Knowledge of InterQual and Milliman Care Guidelines a plus Knowledge of payer contract and payment terminology required Prior leadership experience preferred Experience with acute facility revenue cycle operations preferred

Keywords: Avidity Exchange LLC, Nashville , SSC- Denials & Appeals Supervisor, Other , Nashville, Tennessee

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