Associate Director, Denial Prevention

Closing Date:

The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving patient care and the lives of Arkansans.

UAMS offers amazing benefits and perks (available for benefits eligible positions only):

• Health: Medical, Dental and Vision plans available for qualifying staff and family
• Holiday, Vacation and Sick Leave
• Education discount for staff and dependents (undergraduate only)
• Retirement: Up to 10% matched contribution from UAMS
• Basic Life Insurance up to $50,000
• Career Training and Educational Opportunities
• Merchant Discounts
• Concierge prescription delivery on the main campus when using UAMS pharmacy

Below you will find the details for the position including any supplementary documentation and questions you should review before applying for the opening. To apply for the position, please click the Apply link/button.

Persons must have proof of legal authority to work in the United States on the first day of employment.

All application information is subject to public disclosure under the Arkansas Freedom of Information Act.

For general application assistance or if you have questions about a job posting, please contact Human Resources at askrecruitment@uams.edu.

Department's Website:

• Bachelor's degree in business, nursing, or related field with 5+ years of experience providing consultation, reporting, analysis, and/or dashboard development for revenue focused departments/service lines in a Healthcare provider setting. Management of a clinical area with reporting responsibilities or an equivalent combination of education and relevant experience.
• Proficient computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and internet.
• Experience and proven success in practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.
• Proficiencies - Advanced knowledge of revenue cycle processes and hospital/professional billing to include CDM, UB04, Remittance Advices and 1500 claim form. Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10. Advanced knowledge of NCCI edits, and Medicare LCD/NCDs. Comprehensive understanding of reimbursement methodologies to include DRG, OPPS, professional and facility billing. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.
• Abilities: Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical thinking and the ability to meet deadlines while influencing but not directly managing the work of others.

Preferred Qualifications:

• 7+ years of experience providing consultation, reporting, analysis, and/or dashboard development for revenue focused service lines in a Healthcare provider setting.
• RN, CCS, CPC, CPA.
• Understanding of CPT/HCPCS codes, payer regulations and payer reimbursement.
• Data Visualization experience utilizing Power BI.
• Working knowledge of Epic HB Resolute and PB Resolute.
• Working knowledge of Epic Slicer Dicer.

Additional Information:

*Develop and execute a denial prevention plan that anchors denials resolution processes in the analyses of core analytics, identifying root causes, and identifying proactive and sound approaches to reducing denials.
*Promote collaborative practices with Revenue Cycle stakeholders and facilitate data sharing, providing insight into focus areas, concentrated denial prevention, and management efforts; identify and communicate payer-specific issues for escalation.
*Disseminate information on the impact of changes to government and third-party payer regulations and/or requirements to clinical departments, coding, billing, Revenue Cycle management and staff.
*Create a consolidated denial prevention structure with monitoring; develop a methodology and committee structure to manage performance of the denial prevention function and govern operational changes to prevent future denials; analyze denial trends and coordinate mitigation and denial prevention activities.

*Devise new methods, procedures, and approaches to prevent denials and to introduce and gain support for process improvement.
*Charge Master: represent Denial Management as a member of the CDM committee; request charge modifications and Medicaid charge rolling logic based on new charge set up; monitor and report pharmacy charging issues related to codes, quantity, and pricing to Willow IP team as needed by CDM Committee; work with hospital and clinical departments to develop and execute charge capture and reconciliation processes that support operational efficiency, ensure revenue optimization and minimize missed charging opportunities.
*Clinical Trials: Collaborates with outpatient clinical areas to clarify coding-related issues in documentation; contacts HIM to resolve coding issues which may impact bill generation and/or payment; coordinate clarification of inconsistencies between approved procedures rendered and procedures in the research budget; review research audits/reports for accuracy and compliance; provide oversight for building clinical trial/research billing calendars in Proof of Concept (EPIC build environment module). Management of this task includes review of EAP and PB charge codes that are included in the approved CLARA budget. Ensure all associated charge codes are assigned to the correct protocol timeline (phase or arm) in the treatment plan where the clinical orders are created.
*Unit management: Read, analyze, and interpret contract language in relation to expected reimbursement, compliant billing practices, and clinical trial calendars; prepare clear, complete and concise records, reports, summaries, analysis, evaluations and recommendations for denials. Develop statistical data for upper management to assess and determine issues that impact revenue; remain current with the latest developments, advancements, and trends in Revenue Cycle; conduct charge reviews and claim audits to avoid loss of revenue; responsible for billing compliance regulations. Identify, research, communicate, and resolve errors related to coding, charge capture, billing, insurance verification, late charges, workflows and procedures. * * *Develop process improvements to reduce errors related to coding, charging, billing, and late charges; manage daily operations of the Revenue Support Unit; define short and long term goals, recommend and implement corrective action to enhance the ability of the unit to meet its goals; manage and support various roles from entry level to professional; hire, evaluate, coach, counsel, discipline, and terminate staff as needed; develop, and conduct ongoing training for unit staff.
*Participate in Leadership Development Activities; implement strategies and processes to improve employee morale and performance; provide ongoing feedback regarding productivity and quality.
*Other duties as assigned.

Salary Information:

Required Documents to Apply:

Please contact askrecruitment@uams.edufor any recruiting relatedquestions.

All application materials must be uploaded to the University of Arkansas System Career Sitehttps://uasys.wd5.myworkdayjobs.com/UASYS

Please do not send to listed recruitment contact.

This position is subject to pre-employment screening (criminal background, drug testing, and/or education verification). A criminal conviction or arrest pending adjudication alone shall not disqualify an applicant except as provided by law. Any criminal history will be evaluated in relationship to job responsibilities and business necessity. The information obtained in these reports will be used in a confidential, non-discriminatory manner consistent with state and federal law.