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:
Manages daily operations of the clinical denials management team
Supervises, coaches, and develops clinical denial management specialists
Monitors team performance against established metrics and productivity standards
Reviews and approves clinical appeals for accuracy and quality
Analyzes clinical denial trends and develops remediation strategies
Collaborates with clinical leadership, physicians, and utilization management on denial prevention
Coordinates with payers on complex clinical denial issues and escalations
Ensures compliance with all regulatory requirements and policies
Prepares and presents reports on clinical denial performance
Participates in hiring, training, and performance management processes
Identifies opportunities for process improvement and implements solutions
Performs other duties as assigned
Knowledge, Skills, and Abilities:
Strong knowledge of clinical documentation, medical terminology, and disease processes [Required]
Comprehensive understanding of CPT, HCPCS, ICD coding systems, and clinical billing requirements [Required]
Knowledge of payer policies, regulations, and clinical denial processes for government and commercial payers [Required]
Understanding of utilization review criteria including MCG and InterQual [Required]
Demonstrated leadership skills with ability to supervise and develop staff [Required]
Strong analytical skills with ability to interpret data and identify trends [Required]
Excellent written and verbal communication skills [Required]
Proficiency in Microsoft Suite applications and healthcare information systems [Required]
Ability to build collaborative relationships across departments [Required]
Proficiency with Epic EHR system [Preferred]
Experience with process improvement methodologies [Preferred]
Education:
Field of Study:
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RN with Bachelor’s degree in Nursing, Management or related healthcare field such as: Healthcare Management, Risk Management or Social Work, or RN with at least 5 years direct clinical experience, 8 years Utilization Management experience, demonstrated history of concurrent/post-remit denial management and avoidance experience
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Secondary Bachelor’s Degree (in Business, Healthcare or Health Services Administration, Health Information Management, Communications, Finance, Accounting, Public Administration, Human Resources, Management, or Marketing)
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(in Nursing, Health Management, Business Administration, Finance, or other related area.)
Work Experience:
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2+ in a supervisory/managerial position in a similar-sized hospital [Preferred]
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4+ related work experience in utilization review, care management, revenue integrity, denial management, clinical documentation improvement, or the center for medicare and medicaid services [Preferred]
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Varied clinical experience including nursing in ED, ICU/CCU, OB and/or nursing administration position such as Nurse Manager or Assistant nurse manager [Preferred]
Licenses and Certifications:
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Accredited Case Manager (ACM) [Required] OR
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Registered Nurse (RN) [Required]
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Certified Case Manager (CCM) [Preferred]
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Certified Billing and Coding Specialist (CBCS) [Preferred]
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Registered Health Information Administrator (RHIA) [Preferred]
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Certified Revenue Cycle Rep (CRCR) [Preferred]
Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/23km2677
Pay Range:
$85,529.67 - $159,089.69
Background Screening Requirement (Florida Law)
Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.
Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
