Clinical Appeals Manager
- Requisition ID
- 01 - Days
- Clinical Denials
- Support Services
- Position Type
- Regular Full-Time
- Physical Work Location and New Employee Orientation Location : Address
- 5111 N. SCOTTSDALE RD
- Work Hours (ex:M-F, 8am - 4pm)
HonorHealth is a non-profit, local healthcare organization known for community service and outstanding medical quality. HonorHealth encompasses five acute care hospitals with approximately 11,500 employees and 4,500 volunteers, over 70 primary and specialty care practices, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.
HonorHealth is a leader in medical innovation, talent and technology with a genuine commitment to your growth. The health system's vibrant careers take place in an environment filled with opportunity and respect because we see the HONOR in you.
Bachelor's Degree in Nursing Required
4 years in case management, utilization review, clinical documentation or quality management and 2 years in a leadership role. Required
Licenses and Certifications
Current RN licensure Required
Plans, manages and coordinates clinical denials and charge capture/ED charge posting practices to ensure consistency, meet corporate compliance guidelines, and to ensure appropriate and effective reimbursement in cooperation with the following key areas: Utilization Management, Clinical Documentation, Health Information Management , Patient Financial Services, Admitting/Registration, Information Services, Laboratory and Radiology and Outpatient Surgery Departments, and Innovative Care Partners and hospital-based contracted physicians. Develops policies and procedures to support workflow and guidelines. Recruits, hires and develops RN Auditors to establish, maintain, and keep current an effective training program for clinical denials and charge capture. Recruits, hires and develops ED charge posters to establish, maintain, and keep current an effective training program for ED charge posting and charge capture. Meets budget requirements and participates in budget preparation. Provides education to physician, and physician offices as needed to support hospital operations ensuring accurate and complete medical record. Works with Medical Staff as needed.
- Manages and acts as a resource to the personnel assigned as direct reports. Develops clinical data reporting and uses analytical assessment of data, data manipulation, and professionally articulate data outcomes to improve operations and report to various committees, including but not limited to the Utilization Management and Revenue Cycle committees. Participates and makes recommendations for opportunities to retool and enhance system operations and data management processes
- Acts in a leadership capacity with key areas for initiatives such as physician education and compliance. Oversees professional competency and training of all clinical denials, charge capture, and ED charge posting functions system-wide. Acts as a resource for Physicians. Assists the Corporate Compliance Office when issues arise that directly involve CMS, the OIG, and HSAG.
- Establishes and monitors employee workflows, productivity, and quality. Evaluates staff performance. Initiates recommendations for changes in classification, salary action, promotion, demotion, transfer and termination. Collaborate with Human Resources to settle employee problems and administer appropriate disciplinary action. Interviews, selects and hires personnel.
- Develops and monitors internal key indicator metrics associated with denials and charge capture/ED charge posting as it relates to the revenue cycle. Proactively reviews clinical documentation. Assures evidence based practices by creating an environment that encourages the use of research and vision in developing and improving operational processes.
- Monitors and maintains an effective quality assurance and process improvement plan for clinical denial, charge capture, and ED charge posting processes. Assists in setting annual department and individual performance goals for the upcoming year.
- Develops policies and procedures for system-wide clinical denial, charge capture, and ED charge posting practices to meet Corporate Compliance guidelines and to ensure appropriate and effective reimbursement.
- Develops and maintains designated cost center budgets. Monitors variance against budget on an ongoing basis and reports variances against the budget each month. Performs other duties as assigned.
It is the policy of HonorHealth to provide equal opportunity in employment. Selection and employment of applicants will be made on the basis of their qualifications without regard to race, color, religion, creed, national origin, age, disability, sexual orientation, marital status, veteran status or any other legally protected status.
Please review the Equal Employment Opportunity poster.
Please review the Equal Employment Opportunity Poster.HonorHealth wants all interested and qualified candidates to apply for employment opportunities. If you are an applicant with a disability who is unable to use our online tools to search and apply for jobs, please contact us at EmploymentOffice@HonorHealth.com . Please indicate the specifics of the assistance needed. This option is reserved only for individuals with disabilities that are unable to use the online tools and is not intended for other purposes.