Denials Management Program Manager

OverviewCommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.While you're busy impacting the healthcare industry, we'll take care of you with benefits that include:Medical/Dental/Vision, FSA, Dependent Care Spending Account, Life Insurance, Short and Long-term Disability, 401k match, Paid Time Off, Wellness Program, Tuition Reimbursement, Accidental Insurance, Critical Illness Insurance, Identity Theft Protection, Employee Assistance Program, and more!ResponsibilitiesThis is a remote positionJob SummaryThe Care Coordination Program Manager works under the direction of the System Manager of Payer and Denial Management, this role is responsible for overseeing the development and implementation of projects that support the concurrent denial objectives, and is responsible for managing new concurrent denial initiatives, goals, and strategies. This role is accountable for concurrent denial quality assurance, clinical education, and optimization of denials management reporting. Responsibilities include performing denial audits, providing denial education and operational support, and generating and improving denial reporting. Report generation and analysis is performed to identify key areas of opportunity, identify and promote best practices, and support proper claim submission.Essential Key Job Responsibilities

Provide necessary education to meet quality standards and promote centralized, functional, division denial management teams across CommonSpirit.

Participates in the development of new systems/programs/approaches to enhance existing practices and tools to maximize successful outcomes and performance improvement.

Facilitates and coordinates meetings with internal/external stakeholders - identifying solutions and developing action plans for concurrent denial management challenges.

Collaborates with Acute Care Coordination, Payer Strategy, Revenue Cycle, Physician Advisors and other key stakeholders to identify gaps in process and create solutions.

Provides concurrent denial process and clinical documentation education, training, and support to Division leadership and staff.

Creates educational and audit materials to correspond with software and EHR changes for continuous improvement.

Performs concurrent denial management audits to ensure high quality denial management. Collaborates with Utilization Management (UM) leadership on the development of action plans based on audit results. Provides audit education, training, and support to UM leadership.

Import and/or document concurrent denials management financial data in required platforms for each division.

Collaborate with the Care Coordination analytics team on report creation.

Providing concurrent denial report education and training to division UM leadership as needed.

Keeps apprised of changing regulatory requirements/regulation, professional standards and industry practices impacting assigned functions.

Ensures all duties tasks are completed accurately and delivered with high quality in a timely manner

Performs other duties as assigned.

QualificationsRequired Education and Experience

Bachelor's degree and RN license in the state(s) covered is required.

Minimum three (3) years’ experience in Care Coordination, including utilization review.

Master's degree (MSN, MBA, MPH, MHA, APN) or equivalent education / experience in nursing or healthcare/business related fields preferred.

Three years clinical education experience preferred

Three years auditing/analysis experience preferred

Three years’ experience with denial management, claims review, clinical documentation integrity or similar role preferred.

Pay Range$36.96 - $53.60 /hourWe are an equal opportunity/affirmative action employer.