SPVSR DENIALS & APPEALS

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Position Summary:
Reporting to the Clinical Audit and Appeals Manager, this position is responsible for supervising the resources that perform denial appeals processing for JHHS hospital entities by leveraging the systems and staff towards the achievement of daily, weekly, monthly, and fiscal year performance targets. This individual will assist the Manager in leading, developing, and mentoring staff. In addition, this role will supervise staff using the department's operational policies, guidelines, and code of ethical standards which include respect, diversity, integrity, and collegiality.

The scope of responsibility includes appeals management for administrative and clinical denials by any managed care, commercial, or State/Federal insurance payers until the case is resolved. The supervisor will train staff, conduct audits (staff performance metrics and denial prevention) and assist leadership with the development and enforcement of policies that align with the department goals and objectives. This position will work closely with the patient access, revenue integrity, care coordination, billing, and the compliance departments to ensure maximized revenue recovery on
denied services and is responsible for establishing relationships at all facilities.

Location: 3910 Keswick Road, Baltimore, MD

Hours: 40 hours/Days

Qualifications:

Knowledge:

• Experience in claims processing, third party billing, patient accounts management required.
• Significant experience with word processing, spreadsheets, and graphics.
• Experience in data analysis and report production.
• Must be computer literate and able to learn the multiple systems used for patient registration and billing on all campuses. Familiarity with medical records coding and charting practices is necessary.
• Excellent interpersonal skills to handle sensitive and confidential information. Must possess excellent communication skills to gather and exchange data.
• Must serve as liaison between various departments on issues regarding registration, coding, medical record documentation, and appeals efforts.
• Able to gather and interpret data from multiple sources and resolve problems.

Skills:

• May serve as a liaison with third party payers to establish sound working relationships and communication channels.
• Highly proficient in developing and utilizing spreadsheets and graphics to manipulate large data sets.
• Displays judgment in reviewing accounts to determine appropriate resolution.
• Ability to analyze and trend statistical data to target sources of denial.
• Strong ability to produce reports tracking denied and overturned accounts and communicate findings.
• Possesses excellent written and verbal communication skills necessary to gather and exchange data, and tofacilitate communication cross-departmentally concerning administrative denials
• Possesses excellent interpersonal skills and ability to handle sensitive and confidential information.
• Work requires attention to detail and requires mental/visual acuity.
• Must successfully interact with other departments, including Billing, Appeals, the Office of Managed Care, Financial Clearance, Utilization Management, Patient Accounting, and other Revenue Cycle departments.

Work Experience:

Eight or more years' experience in healthcare revenue cycle or denials management.

Education:

Bachelor's Degree in Business, Health Administration, or related field and a minimum of 8 years experience in healthcare revenue cycle or denials management.

Salary Range: Minimum $27.05/hour - Maximum $47.35/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.

In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

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Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.