Director Clinical and DRG Denials

72111BR

Auto req ID:

72111BR

Department:

24068 - Clinical Revenue Cycle Admin

Job Description:

The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue Cycle department. Directs performance improvement initiatives, develops and maintains operational policies for the department and assures regulatory compliance is a priority. Specifically, develops strategies and tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development and implementation of policies and procedures.

The Director, Clinical & DRG Denials will work collaboratively with physicians, nursing staff, Quality, Finance and others to develop, implement and maintain strategies that capitalize on facility and industry best practices to achieve targeted outcomes.

Identifies, communicates and holds staff accountable for performance expectations; monitors/appraises the job results/performance and promotes a positive, team-oriented work environment. Develops relationships and influences payer policies and procedures as well as facilitating strong working relationships between HIM, Clinical Documentation, UR, Physician Advisor operations, PFS, Contracting, and hospital departments and leadership to promote effective clinical validation improvement and clinical denial management system-wide. Significant influence on system quality and financial outcomes.

Buffalo, NY

Location:

Larkin Bldg @ Exchange Street

Recruiter:

Casey Calandra

Minimum or Preferred Qualifications:

BA or BS in health related field required. MHA or MBA preferred. 10 years of experience in a healthcare environment required. 8 years of experience with Insurance Carriers, Payer policy trends and Revenue Cycle management concepts required. 5 years of experience in a large, complex acute care setting in a supervisory / administrative role required. 5 years of experience with Basic computer skills including Microsoft word, Microsoft excel with spreadsheet development and utilization, Microsoft outlook required. 8 years of experience in a multi- hospital system and / or managed care required. 10 years of experience with Federal, state and accreditation guidelines. financial principals, reimbursement methodologies, coverage issues, documentation, coding conventions and insurance / managed care practices including but not limited to: utilization review, RAC, MAC, Q10, clinical and DRG denial management required. Reg Health Info Tech (RHIT) required upon hire. RHIA, CDAM, CCS preferred.

Status:

Full Time

Shift:

Days

Scheduled Work Hours:

8a-5p

Salary Range:

$95,503-$149,366 annually Wage will be determined based on factors such as candidate's experience, qualifications, internal equity, and any applicable collective bargaining agreement.

Grade:

15

Position:

Director Clinical and DRG Denials

Union Code:

00 - Non Union

Bi-Weekly Hours:

75

Weekend/ Holiday Requirement:

No Weekends or Holidays Required

Equal Opportunity Employer

Kaleida Health is committed to diversity and believes our workforce is strengthened by the inclusion of and respect for our differences.

Kaleida Health is an equal opportunity and affirmative action employer. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, religion, sex, national origin, citizenship status, creed, gender, gender identity or expression, sexual orientation, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for or perform your job.