The denial manager assumes responsibility and accountability for managing denials and reimbursement for third-party payers, as well as vendor denial management relations at Beebe Healthcare and Beebe Medical Group. This includes overseeing the denial process used by both in-house staff, affiliated denial management vendors, and continually working to identify opportunities for workflow improvements. The manager collaborates with the Revenue Cycle Directors and other team members to set departmental goals, measure process effectiveness and productivity and identify any need for updated policies and procedures. Reporting to the Revenue Integrity Director, the denial manager serves as a liaison to revenue cycle staff, clinical departments, payers, and patients by ensuring effective communication between all parties.
Bachelor's degree or have 5 years of experience and are currently enrolled working on completing their Bachelor¿s degree
Maintains responsibility of the in-house and vendor denials management process; and supervises
compliant application of departmental and organizational policies, procedures, and standards
Tracks the status of all denial response efforts carried out by Beebe Healthcare denial management
staff and vendors through overseeing and maintaining Beebe Healthcare's denial tracking tool
Maintains the internal denial tracking tool by extracting data for reports, training and educating
staff on proper utilization, and updating software as needed
Provides direction and support to denial management staff by adhering to an established
educational plan to ensure quality and productivity standards are met
Through collaboration with business office management, sustains appropriate staffing levels for
the denial management team and coordinates overtime costs within the pre-determined budget
Gathers and assembles documentation related to denial trends and root causes for committee
meetings and regular check-ins with Beebe Healthcare and vendor leadership
Meets with various revenue-generating departments to communicate root causes of denial (i.e.,
discrepancies in patient account information, documentation) and provides direction to mitigate
denials in the future
Oversees the appeals process, which includes assessing, documenting, and/or guiding the
resolution of denials processed by the denial management team and/or vendor
Acts as the primary liaison between the denial management vendor and the organization
Facilitates the assignment of appropriate accounts to the denial management vendor
Has primary responsibility for resolving problems and rectifying inefficiencies related to denial
management vendor processes and relations
Manages contract negotiations and renegotiations with denial management vendor or vendor
Serves as a resource for patients, vendor staff members, and revenue cycle personnel to expediently
address and resolve questions and/or concerns
Executes excellent customer service and professionalism when interacting with staff, vendor
representatives, payers, patients, and families to ensure all are treated with kindness and respect
Through leadership and by example, ensures that services are provided in accordance with state and
federal regulations, organizational policy, and accreditation/compliance requirements
Demonstrates knowledge of Beebe Healthcare's safety policies and procedures by maintaining a
safe work environment
Performs additional assignments and maintains current knowledge of the denial management
field by independently following industry trends, as well as by completing any required ongoing
training and instruction
Consults with department managers to help develop and implement policies and procedures for the purposes of reconciling charges posted in the billing system with other source information
Develops tools for the purposes of tracking and identifying potential areas of lost revenue
Competencies and skills: Essential: * Clear Communication Skills Both Written And Verbal * Knowledge Of Basic Computer Programs * Able To Keep Confidential Information Regarding Patients, Team Members * Able To Withstand Crisis Situations * Has Skills To Provides Customer Service To Patients, Team Members And Visitors * Experience Or Completed Courses In Coding
Education: Essential: * High school graduate or equivalent Nonessential: * Bachelor's Degree in related field
Education equivalent experience: Nonessential: * Bachelor's degree or have 5 years of experience and are currently enrolled working on completing their Bachelor¿s degree
Beebe Healthcare serves the Sussex County community with a medical center located in beautiful, historic Lewes, Delaware, and convenient outpatient locations throughout the county. Founded in 1916 by two physician brothers, Drs. James Beebe and Richard C. Beebe, the medical center in Lewes is a 210-licensed-bed, not-for-profit seaside community hospital. Beebe's specialized service lines include cardiac and vascular, surgical services, oncology, women's health, and orthopaedic services. Beebe offers an array of inpatient, outpatient, emergency, and diagnostic services.
Beebe's five satellite campuses offer imaging, physical rehabilitation, and lab services, as well as walk-in care centers. In addition, Beebe offers Wound Healing & Hyperbaric Medicine and Diabetes Management & Medical Nutrition Therapy.
With a mission to serve the community, Beebe also offers many free screenings and outreach programs through its Population Health Department; and advanced medical care for those who are recuperating at home through Beebe Home Care Services.
Beebe is also training the next generation of nurses through the Margaret H. Rollins School of Nursing, located behind the Medical Cente...r in Lewes.
Beebe's Medical Staff has grown tremendously since the early 1990s. Employed physicians through Beebe Medical Group and our affiliated physicians on Beebe's Medical Staff now serve patients from Milford to Millville in specialties including cardiac surgery, dermatology, endocrinology, family practice, gastroenterology, general surgery, internal medicine, pediatric neurology, and surgical oncology.
Beebe is proud to offer quality care, close to home for the residents and visitors of Sussex County.