Director - Enterprise Denials Management

February 19

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WVU Medicine

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WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

neurosurgery • pediatrics • emergency medicine • cardiothoracic surgery • cancer services

10,000+ employees

⚕️ Healthcare Insurance

📋 Description

• Manages the enhancement and overall effectiveness of a centralized denials prevention and management group which minimizes revenue leakage for the revenue cycle. • This position is responsible for implementing and maintaining enterprise level denials prevention and mitigation approach. • Develops and controls all activities necessary to accomplish project and department requirements, including building relationships with internal and external clients throughout WVU Medicine, especially finance and clinical leadership. • Utilizes internal resources and analytical skills to make decisions in fast-paced, fluid environment. • Accountable for making decisions guided by organizational issues, trends, and business implications, keeping in mind that decision may have regional/local implications. • Establishes new process improvement policies, functions, and objectives to best support the needs and success of the organization related to denials prevention. • This position is responsible for directing and administering a centralized team of denial nurses, denial assistants, audit specialists, management and staff. • The director will be responsible to lead and establish strategic initiatives around clinical medical necessity denials including new procedures, guidelines, and committees to support the mission of the department and stakeholders. • This position will work closely with clinical, operational, utilization management, managed care, legal, and financial stakeholders to ensure we have a centralized denials prevention and management approach. • Continually monitors and optimizes all aspects of denials and recoupment efforts including appeals. • Writes, interprets, adapts, and enforces Hospital and departmental policies as needed with management, employees, and customers. • Serves as representative of department and team within the organization. Integrates department operations into clinical hospital operations where needed and engages department leadership in any denials and appeal related activity. • Monitors annual operating and capital budgets for department, preventing and reporting variances where required. • Advises finance executives, Epic IT Team, and clinical departments of billing implications of operational decisions. • Prioritizes projects with management team. Work with management team to develop a project plan for implementation of process improvement projects and new partnerships with vendors, departments, and providers. • Maintain technical understanding and operational dependencies of system charging activities including charge generation, capture, routing, and billing and apply to risk and root cause analyses and recommendations.

🎯 Requirements

• Bachelor’s Degree in Healthcare, Finance, Business, or related field • Five (5) years of management experience • Five (5) years of experience in healthcare finance.