Hours

Shift Start Time:

Variable

Shift End Time:

Variable

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$39.435 - $50.884 - $62.333

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
The Supervisor of Denials-PFS is responsible for reviewing all denial material and ensuring accurate second level appeals are filed for denied claims.

Required Qualifications

• 4 Years experience in hospital/clinic system, preferably business services.

Preferred Qualifications

• Conversion experience and/or systems experience.

Other Qualification Requirements

• Bachelor's degree in an applicable field such as Information Systems, Business Administration, or Healthcare Administration; equivalent work experience may substitute for education. - Required

Essential Functions

• Department competency
  Maintain knowledge base of current regulations of affiliated payors through coordination with Contract Reimbursement Specialist.
  Centralizing and reviewing all denial material (correspondence, EOBs, zero payments on acct, etc., notes in IDX from clinical/financial staff).
  Working with Insurance Specialist to identify additional denial write offs as contractual adjustments and correct.
• Financial analysis and reporting
  Trending and analyzing denials and recoveries (reversals) on a monthly and FY to date basis, identifying root causes, responsible departments and individuals throughout the revenue cycle.
  Reporting denials by payor, including total open cases, resolved cases and % of individual payors' net receivables.
  Tracking denial write-offs as a percentage of net revenue.
  Facilitating presentation of findings to management (CFOs, Managers, VPs etc.).
  Proposing recommended improvements to reporting (including potential usage of Access database, automated reports/charts and broad accessibility). Incorporate/crosswalk payor X12 codes to Sharp's denial reasons.
  Improvements to ensure accurate tracking of denials.
• Staffing
  Leading team of 5-6 account analysts to ensure accurate second level appeals are filed for denied claims.
  Compiling learning points by team and using them to train account analysts who file first level appeals.
  Creating reward and recognition programs to motivate the staff to achieve/exceed goals.
• System integration
  Researching and successfully implementing best practice strategies to improve organization's financial outcomes thought root cause analysis of denials.
  Documenting action plan.
  Measuring efficacy of newly implemented strategies on a go forward basis and modify if necessary. This includes but is not limited to PAS staff, Utilization Management, MDs, PFS staff, IS Billing and contracts department for future negotiations.

Knowledge, Skills, and Abilities

• Proven analytical/problem solving skills.
• Competency in data collection and mining, report and chart creation, and spreadsheet analysis Team player, self starter, detail oriented (if current PFS employee, demonstrated high accuracy in transactions, write-offs, refunds, issue resolution, etc.)
• Knowledge of Managed Care Contract Reimbursement, Government Reimbursement and medical terminology preferred.
• Strong verbal and written communication skills.
• Ability to work independently as well as in Cross-functional Teams (medical and financial staff, MDs).
• Proficient in Excel, Outlook, and Word (including charts, graphs and tables).

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class