Manager, Denial Prevention & Process Improvement
Adventist HealthLocated in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Serves as a primary contact and facilitator between shared services revenue cycle operations and market operational departments for denials review and prevention coordination. Communicates to patient financial services, market revenue cycle management (MRCM) team, and market operational leadership current and historic denials metric. Provides insights into operational processes which influence initial claim denials and final account write off accounts. Works in coordination with the shared services, MRCM, utilization management, care management, and market operational leadership to develop targeted action plans to prevent claim denials. Provides quality support services to maintain a high level of operational accountability and continue to elevate revenue cycle operations to deliver an exceptional experience. Ensures clear communication and an effective relationship between all revenue cycle and market operational departments.
Job Requirements:
Education and Work Experience:
- Bachelor's degree in business administration, accounting, finance, information technology, or health administration, or equivalent experience within revenue cycle operations, revenue metrics and analytics, and revenue management, or equivalent combination of education and experience: Required
- Master's Degree: Preferred
- Five years' of acute and ambulatory experience in a multi-facility, integrated health care delivery system within revenue cycle: Required
- Five years' leadership experience in a multi-facility, integrated health care delivery system or consulting experience. Experience with Cerner, Epic, and/or EHR conversion: Preferred
- One year leadership experience: Preferred
Essential Functions:
- Completes denial reason analysis. Identifies denial trends. Determines root cause mitigation recommendations. Monitors integrity of the claims submission process.
- Supports recurring denial prevention meetings with all stakeholders. Participates in interdepartmental resolution strategies. Maintains data on the types of claims denied and root causes of denials and collaborates with appropriate parties to make recommendations for improvements and resolving issues.
- Coordinates and facilitates educational programs for revenue cycle department leaders. Creates materials and trains denial prevention staff, revenue cycle leaders, and committee members as necessary on denial-related trends. Develops and implements administrative procedures and review of current processes.
- Supports maintenance or third-party payer relationships, including responding to inquiries and coordinating meetings. Collaborates with patient financial services for escalation priorities and accounts for review.
- Ensures alignment with organizational priorities. Collaborates with MRCM team to ensure cohesive communication to market operational leadership. Presents to large groups which may include market or senior leadership. Organizes data in a professional way to communicate with leadership.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.