[Hiring] Manager, Appeals & Denials @Accuity

Role Description

The Manager, Appeals and Denials is responsible for the day-to-day Appeals and Denials process by providing general oversight including leadership for the inpatient DRG/Coding Denials and Appeals process. Key responsibilities include:

• Tracking, prioritizing, trending and writing appeal letters.
• Identifying training and educational opportunities.
• Delivering training and education to CDI Appeals Specialists, Coders and DRG reviewers.
• Collaborating with the Appeals and Denials Team, CDI Team, Appeals Medical Director, Coding, DRG Team, and client healthcare team members.
• Providing appeal letters that result in accurate, comprehensive documentation reflecting the true clinical picture of the patient.
• Utilizing clinical expertise and clinical documentation improvement practices, current coding guidelines, and state and federal regulations for ethical coding.

Qualifications

• Registered nurse or Coding degree or certification, or Degree in Healthcare (Management, Healthcare Administration, Health Information Management) or other related field(s) required.
• Minimum of 5 years appeals/denials or coding experience in the inpatient coding arena.
• Minimum of 5 years of Management experience.
• CCDS and/or CDIP certification or RHIA, RHIT certification(s) preferred.

Requirements

• Ensures compliance with external agencies as well as state and federal regulations for ethical coding.
• Identifies and implements improvement measures that will enhance coding quality and client satisfaction.
• Demonstrates appropriate knowledge and judgment regarding denials received from clients.
• Supports education of the remote and onsite coding staff and appeal writers.
• Identifies and documents patterns, trends and variations in coding data and collaborates with other departments to effect resolution.
• Monitors the initiation, revision, and implementation of external regulations, statutes, and standards.
• Assists with chart audit and analyzes denial letters, making recommendations for education, counseling or termination of staff as appropriate.
• Reviews provisions for staff development, training and orientation prescribed by customers and any internal departmental standards.
• Reviews denials received by client base, determines if denials are clinical or coding related, and develops and delivers training based on trends identified.
• Assists with maintaining the integrity of data entry into Appeals and Denials tracking software.
• Ensures adequate staffing for workload and assists teams when workload supersedes what the team can complete.
• Reviews No Appeal letters to determine if appropriate, or if it can be appealed and provides Appeal Writer with feedback.
• Assists Director Denials and Appeals Team with projects or tasks as assigned.
• Performs miscellaneous job-related duties as assigned.

Company Description