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.

The University of Arkansas is an equal opportunity, affirmative action institution. The University does not discriminate in its education programs or activities (including in admission and employment) on the basis of age, race, color, national origin, disability, religion, marital or parental status, protected veteran status, military service, genetic information, or sex (including pregnancy, sexual orientation, and gender identity). Federal law prohibits the University from discriminating on these bases. Questions or concerns about the application of Title IX, which prohibits discrimination on the basis of sex, may be sent to the University's Title IX Coordinator and to the U.S. Department of Education Office for Civil Rights.

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.

At UAMS we value Diversity, Equity and Inclusion.

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

Department's Website:

Minimum Qualifications:

• 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 departments/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:

Additional Information:

• Responsible for working with hospital and clinical departments to development and execution of a charge capture and reconciliation process that supports operational efficiency, ensures revenue optimization, and minimizes missed charging opportunities across all hospital and clinical departments.
• This position is responsible for managing revenue cycle analysts and charge capture analyst.
• This position oversees the Clinical Trial claims up to billing ready including clinical trial calendars and two-tier review.
• Position responsible for revenue guardian checks.
• In addition, incumbent is required to sit on the charge master committee.
• Develop and execute a denial prevention plan that anchors denials resolution processes in the analyses of core analytics, identifying root causes, and identify proactive and sound approaches to reducing denials.
• Promote collaborative practices with revenue cycle stakeholders and facilitates data sharing providing insight into focus areas, concentrated denial prevention, and management efforts. Identifies and communicates payer-specific issues for escalation
• Facilitates the dissemination of information regarding the impact of changes to government and third-party payer regulations and/or requirements to clinical departments, coding, billing, revenue cycle management and staff
• Denials-create a consolidated denial prevention structure with monitoring; Develop a methodology and committee structure to manage the performance of the denial prevention function and govern operational changes that may be necessary to prevent future denials in all areas of the revenue cycle from occurring. Monitor, analyze denial trends and coordinate mitigation and denial prevention activities when opportunities for improvement are identified.
• Devise new methods, procedures, and approaches to prevent denials across the organization and be able to introduce and gain support for process improvement
• Requests charge modifications and Medicaid charge rolling logic as needed based on new charge set up. Monitors and reports all pharmacy charging issues related to codes, quantity, and pricing to Willow IP team as needed by CDM Committee. Responsible for working with hospital and clinical departments to development and execution of a charge capture and reconciliation process that supports operational efficiency, ensures revenue optimization and minimizes missed charging opportunities across all hospital and clinical departments
• 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. Coordinates clarification of inconsistencies between approved procedures rendered and procedures in the research budget through communications with department staff and research staff. Reviews research audits / reports for accuracy and compliance with research billing guidelines. Responsible for 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. Ensuring all associated charge codes are assigned to the correct protocol timeline (phase or arm) in the treatment plan where the clinical orders are created
• Demonstrates ability to accurately read, analyze, and interpret contract language in relation to expected reimbursement, compliant billing practices, and clinical trial calendars. Prepares clear, Complete and concise records, reports, summaries, analysis, evaluations and recommendations for denials. Develops statistical data for upper management to assess and determine issues that impact revenue as needed. Stays current with the latest developments, advancements, and trends in the revenue cycle field. Conducts charge reviews and claim audits to avoid loss of revenue. Responsible for billing compliance regulations. Identifies, researches, communicates, and resolves errors related to coding, charge capture, billing, insurance verification, late charges, workflows and procedures. Develops process improvements to reduce errors related to coding, charging, billing, and late charges. Effectively manages the daily operations of the Revenue Support Unit. Defines short and long term goals, recommends and implements corrective action which enhances the ability of the unit to meet its goals. Manages and supports various roles from entry level to professional. Hires, evaluates, coaches, counsels, disciplines, and terminates staff as needed. Participates, develops, and conducts ongoing training for unit staff.
• Participates in Leadership Development Activities; implements strategies and processes to improve employee morale and performance. Provides ongoing feedback to team regarding productivity and quality. Manages staff and provides coaching, mentoring, and feedback
• 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.