Director Clinical Denials

**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. **All the benefits and perks you need for you and your family:** - Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance - Paid Time Off from Day One - 403-B Retirement Plan - 4 Weeks 100% Paid Parental Leave - Career Development - Whole Person Well-being Resources - Mental Health Resources and Support - Pet Benefits **Schedule:** Full time **Shift:** Day (United States of America) **Address:** 900 HOPE WAY **City:** ALTAMONTE SPRINGS **State:** Florida **Postal Code:** 32714 **Job Description:** Oversees personnel involved in audit and clinical denials management to optimize customer experience and maximize reimbursement. Provides leadership and support to staff responsible for managing denials and appeals processes. Develops and implements strategies to reduce clinical denials and improve reimbursement rates. Analyzes denial trends and identifies root causes to develop effective prevention strategies. Collaborates with other departments to ensure accurate and timely resolution of denials. Monitors and reports on key performance indicators related to denials management. Ensures compliance with all relevant regulations and guidelines in the denials management process. Provides training and development opportunities for staff to enhance their skills and knowledge. Utilizes data analytics to identify areas for improvement and implement process enhancements. Communicates effectively with payers, providers, and other stakeholders to resolve denials and appeals. Develops and maintains policies and procedures related to denials management. Manages the budget and resources for the denials management team.**Knowledge, Skills, and Abilities:** • Strong organizational skills [Required] • Effective oral and written communication skills, with the ability to articulate complex information to all levels of colleagues [Required] • Strong keyboard and 10 key skills [Required] • Proficiency in Microsoft Suite applications, specifically Excel, PowerPoint, Word, and Outlook [Required] • Ingenuity and judgment are required to review facts, plan work, estimate costs, interpret results, draw conclusions and take or recommend action [Required] • Have a good understanding of payer requirements related to authorization and denial functions as well as reimbursement of all payers including but not limited to Government, Medicaid, Medicaid HMO products (i.e. VA, Tricare, Crimes Comp, Prisoners, etc.) and Managed Care / Commercial products [Required] • Uses discretion when discussing personnel/patient related issues that are confidential in nature [Required] • Comprehensive understanding of how Medicare DRG rates, Medicare APC rates, Medicare Fee Schedules, and Medicaid payments are calculated [Required] • Demonstrated ability to be self-directed and work with minimal supervision/oversight [Required] • Able to work in a project-oriented environment with people of various background [Required] • Comfort with interpreting insurance contractual language [Preferred] • Knowledge of InterQual and MCG as well as CMS LCD/NCD documentation [Preferred] • Varied clinical experience including nursing in ED, ICU/CCU, OB and/or nursing leadership position [Required] • Basic knowledge of charge master systems [Required] • Basic understanding and ability to navigate in DDE (online Medicare billing) [Required] • Understanding of PFS registration and billing processes [Required] **Education:** • Bachelor's [Preferred] • Ba…