Job Information

Providence Supervisor Clinical Denials PSJH *Telecommute* in Washington

Description:

Providence St. Joseph Health is calling a Supervisor Clinical Denials PSJH to work remotely within our footprint states: AK, CA, MT, OR, TX and/or WA.

We are seeking a Supervisor Clinical Denials PSJH who will provide a key system role in facilitating day to day operations and managing the clinical denials program for Providence St. Joseph Health (PSJH) Revenue Cycle in partnership with RCE Manager and Director of Clinical Denials. The Supervisor has a strong clinical background blended with well-developed knowledge and skills in medical necessity, revenue cycle, as well as regulatory and reimbursement requirements of commercial and government payors. Demonstrated clinical expertise related to a wide variety of patient populations and care delivery models.

The RCE Clinical Denials Supervisor partners with RCE Clinical Denials Manager to identify opportunities for the development, implementation, evaluation, and ongoing revision of initiatives to clinical denials management process efficiency, consistency, as well as cost-effectiveness. Develops and monitors a quality improvement plan for clinical denials program functions and processes. Provides routine reports to RCE Clinical Denials Manager. Proactively communicates with Manager regarding variances and recommended action plans

In this position you will have the following responsibilities:

  • Demonstrated understanding of compliance and regulatory requirements from Center for Medicare and Medicaid Services, payor contractual requirements and other regulatory agencies.

  • Develops and supervises the implementation of department policies and procedures to ensure compliance with statutory, regulatory, accreditation, and contractual requirements.

  • Strong knowledge of various aspects of Revenue Cycle: prior-authorization, status determination, and denials management.

  • Demonstrated ability to evaluate medical necessity and other Revenue Cycle as well as Case Management/Utilization Management activities and criteria platforms.

  • Knowledge around InterQual and MCG (Care Enhanced Review Management, electronic) programs.

  • Knowledge of reimbursement requirements, strategies, denial process and denial appeal management.

  • Responsible for the hiring, performance management, and annual evaluations for Clinical Denials caregivers.

  • Ensures that new employees are oriented to their division and are well-trained for their scope of work. Leads and coordinates the orientation process.

  • Ability to train, coach, motivate and supervise caregivers as well as holding staff accountable.

  • Develops staff schedules to ensure adequate coverage to meet business needs. Leads and coordinates assignments of duties to include performance improvement activities in clinical denials.

  • Maintains appropriate systems and scorecards for measuring necessary aspects of operational management and development.

  • Manage and oversee operational efficiencies and reduce delays in workflow processes.

  • In partnership with RCE Clinical Denials Manager, accountable for ensuring productivity standards, goals and objectives are met. Maintains budget expectations.

  • Responsible for keeping caregivers current and informed of changes to standards, policies, procedures, etc.

  • Excellent interpersonal, communication, and presentation skills.

  • Other duties as assigned

Qualifications:

Required qualifications for this position include:

  • Bachelor's Degree in Nursing or equivalent education/experience.

  • 5 years recent acute care experience or relevant clinical denial management experience.

  • 1 year recent Revenue Cycle/Case Management/Utilization Management experience.

Preferred qualifications for this position include:

  • Master's Degree in Nursing, Business, Healthcare Administration, or other related field -OR- quivalent education/experience.

  • Knowledge of Epic workflows.

  • 2 years leadership experience in Revenue Cycle/Case Management/Utilization Management.

About the department you will serve.

One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence Health & Services (PH&S) in revenue cycle systems and structures in support of our ministries and operations in all regions from Alaska to California. ORC’s objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise.

We offer a full comprehensive range of benefits — see our website for details —http://www.providenceiscalling.jobs/rewards-benefits

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Non-Clinical Lead/Supervisor/Manager

Location: California-Irvine

Other Location(s): Montana, California, Washington, Oregon, Texas, Alaska

Req ID: 357613