Position Overview:

This position is responsible for overseeing staff and all activities of the enterprise related to denials management within the OPT Denials Management Program and OPH Denials Management Program. The Denials Management Director is accountable for identifying and reducing denial trends (initial and write-offs) to increase cash collections.  Responsibilities include; measuring and monitoring denial performance against established benchmarks, identifying denial trends and facilitating root cause discovery and action plans, and presenting denials performance to executive leadership.

Essential Duties and Responsibilities: The following are general responsibilities associated with the job and are listed in order of greatest to least amount of time spent on the duties. 

• Run and pull denial reports for both OPH and OPT Denials Management Programs from Waystar on a weekly/bi-weekly basis.
• Review bill-edit and denial information to identify significant denial trends and preventable root cause issues.
• Document trends within reporting trackers as well as in presentations for stakeholders.  Monitor and manage denial rate performance against established benchmarks
• Establish and manage relationships with leadership by facilitating regular meetings to present, review, and obtain updates on denials information; discuss issues and trends; and ensure effective action plans to reduce denials are developed and carried out effectively and timely.  
• Monitor month-end metrics to understand baseline variances and present explanations to ECP Leadership comprised of enterprise stakeholders. 
• Appropriately utilize industry information and ECP peer resources to understand national and regional denial trends, peer physician practice innovations and successes relating to denial management.
• Successfully integrates new acquisitions into existing denials management program and reporting structure
• Set productivity and quality standards to hold staff accountable and ensure denied accounts are monitored, followed up on, and written off in accordance with ECPs policies. 
• Maintain an understanding of the workings of the billing department, as well as registration and charge capture processes in the clinics.
• Proven ability to manage multiple projects at a time while paying strict attention to detail
• Ability to successfully meet demanding timelines
• Displays eagerness to accept additional responsibilities at the discretion of management
• Makes decisions in an ethical/effective/sound manner, adheres to corporate compliance/risk management/safety standards, displays an open-minded attitude, establishes priorities, conceptualizes, and organizes time and resources to accomplish the job.
• Adheres to ECP confidentiality policy which includes verbal, written, computer generated, computer accessed, filmed and recorded information related to patients, their family and visitors, staff, physicians, and clients.  Responsible for the protection of confidentiality of data at all times.
• Works in a safe manner and follows all ECP safety requirements.  Reports all incidents, near misses, and adverse events.

Preferred Qualifications: While not required, the following are preferred qualifications associated with the job and will be under consideration. 

• Preferred minimum 8 years of denials management, billing, or follow-up experience within a physician’s office or medical environment
• Experience in Optometry/Ophthalmology physician practice environment preferred
• NextGen and Waystar software experience preferred

Job may require other duties as assigned.

Education and Experience: The minimum level of education and experience required to perform the job at a satisfactory level.

• Bachelor’s Degree preferred, however, progressive career experience in a patient financial services role will be given strong consideration.  
• Knowledge of CPT coding, Medicare/Medicaid regulations, and managed care contractual billing required.  
• Proficiency in Microsoft Office, especially Excel required.

Knowledge, Skills, and Abilities: The minimum level of knowledge, skills, and abilities to perform the job at a satisfactory level.

• Maintain a complete understanding of denials management protocols and required software systems
• Develop and maintain a working knowledge of payer rules and guidelines
• Track trends, inconsistencies, or discrepancies and resolve and/or escalate to a supervisor as appropriate
• Decision Making: Common decisions made in the job and the level of review or autonomy needed to finalize such decisions. 
• HIPAA compliance is strictly followed in accordance with industry regulations
• May make recommendations regarding policies associated with the job’s purpose and essential responsibilities.  

Work Environment: Environmental or atmospheric conditions commonly associated with the performance of the functions of this job. 

• General office conditions.

Physical Requirements: Activities that are commonly associated with the performance of the functions of this job. The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. 

• While performing the duties of this job, the employee is regularly required to stand and walk and sometimes sit; use hands to type, handle, or feel objects or controls; reach with hands and arms; and talk or hear.  
• Occasional travel may be required.