[Hiring] Clinical Denials & Appeals Supervisor @ECU Health Medical Center

Role Description

Coordinates and directs the daily activities of the Clinical Appeals Specialists responsible for appeals on denied claims for ECU Health System.

• Determines professional learning needs of staff and identifies short/long-term goals relevant to position.
• Reviews and evaluates daily work queue inventory to ensure adequate and timely follow up is performed and the workload is equally distributed.
• Reviews and approves contractual, administrative and legally unbillable adjustments in accordance with the policy.
• Stays current on all of the contractual agreements with third party payers and represents area in payer escalation/relation meetings.
• Liaison for Managed Care reimbursement resolution.
• Responsible for ongoing staff training & development, scheduling, performance evaluations and time and attendance.
• Assists in hiring of staff.
• Stays current on the federal, state & local government regulations and the claim reimbursement & denials.
• Performs other related responsibilities to assist manager as required or requested.

Qualifications

• Bachelor's degree or higher is required.
• 3 to 4 years of experience in insurance/denials is required.
• ADN degree required. A BSN degree can substitute for an ADN degree.
• Two years of experience beyond 4 years can substitute for the Associates degree.
• RN Licensure required.

Requirements

• Ensures that the policies and procedures are followed.
• Evaluates and ensures Ins Reps are performing duties.
• Reviews/approves adjustments in Supervisor Adjustment WQ.
• Supervises Staff and interviews/hiring of new employees.
• Reviews, analyzes, and communicates payer and Governmental communications and/or bulletins.
• Responds to special request by management.
• Adheres to the policies and procedures.
• Promotes a positive image and supports management in goals and objectives.
• Supervises RNs.

Benefits

• Remote role (based out of Greenville, NC)
• Monday - Friday, full-time, day shift
• Great Benefits

Company Description

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.