[Hiring] Manager, Appeals & Denials @Accuity

Role Description

The Manager, Appeals & Denials is responsible for the day-to-day management and oversight of the inpatient DRG Downgrades and appeals process. This includes:

• Tracking, prioritizing, and trending denials
• Writing appeal letters
• Identifying training and educational opportunities
• Delivering education to CDI Appeals Specialists, Coders, and DRG Reviewers

The Manager supports the Appeals & Denials program through:

• Staff oversight
• Auditing and reporting
• Mentoring
• Strengthening client relationships by ensuring the delivery of high-quality appeal letters for Accuity clients

This position collaborates with various teams to develop appeal letters that support accurate, comprehensive documentation reflecting the true clinical picture of the patient.

Responsibilities

• Appeals & Denials Operations:
  • Distributes daily assignments and monitors updates
  • Reviews denials and determines next steps
  • Tracks and trends denial data
  • Writes and supports quality appeal letters
  • Reviews No Appeal letters and provides feedback
  • Maintains integrity of data in tracking software
  • Ensures adequate staffing and assists teams during high workload
  • Conducts regular audits for quality and compliance
• Leadership and People Management:
  • Provides supervision, mentoring, and development to staff
  • Conducts annual performance evaluations
  • Reviews and approves employee timecards
  • Manages staffing resources and time-off requests
  • Supports onboarding and training initiatives
  • Assists with audits and analyzes appeal letters
  • Identifies training opportunities and develops education
• Compliance and Quality:
  • Ensures compliance with external agency requirements
  • Implements improvement measures for coding quality
  • Documents patterns and trends in coding data
  • Monitors regulations and facilitates implementation
  • Interprets coding quality audit data and tracks results
• Cross-Functional Collaboration:
  • Collaborates with various teams for accurate appeals
  • Establishes cooperative working relationships
  • Supports client satisfaction through high-quality appeals
• Other Duties as Assigned:
  • Assists the Director, Denials & Appeals with projects
  • Performs miscellaneous job-related duties

Qualifications

• Registered Nurse or degree in Healthcare Management, Healthcare Administration, Health Information Management, or related field required
• CCDS and/or CDIP certification or RHIA/RHIT certification preferred
• Minimum of 5 years of appeals/denials or coding experience in the inpatient coding arena
• Minimum of 5 years of management experience
• Extensive knowledge of revenue cycle management and coding services
• Demonstrated knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and modifiers
• Experience with electronic health records and health information systems
• Demonstrated ability to interpret coding quality audit data
• Proficiency using a PC in a Windows environment, including Microsoft Word

Requirements

• Strong interpersonal and customer service skills
• Highly motivated and self-directed
• Strong analytical and problem-solving skills
• Demonstrated leadership skills, including accountability and decision-making
• Highly developed written and verbal communication skills
• Strong organizational and prioritization skills
• Ability to manage competing priorities

Additional Requirements

• Physical Requirements: Interaction with people and technology while either sitting or standing
• Position and Employment Statement: Management reserves the right to modify duties as necessary