What are the responsibilities and job description for the Supervisor of Clinical Denials & Appeals - Central Business Office Management position at ECU Health?
ECU Health
About ECU Health
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 Childrens 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.
Position Summary
The Supervisor of Clinical Denials & Appeals coordinates and directs the daily activities of the Clinical Appeals Specialists responsible for appeals on denied claims for ECU Health System.
As the Supervisor of Clinical Denials & Appeals, you will:
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
About ECU Health
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 Childrens 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.
Position Summary
The Supervisor of Clinical Denials & Appeals coordinates and directs the daily activities of the Clinical Appeals Specialists responsible for appeals on denied claims for ECU Health System.
As the Supervisor of Clinical Denials & Appeals, you will:
- Determine professional learning needs of staff and identifies short/long-term goals relevant to position.
- Review and evaluate daily work queue inventory to ensure adequate and timely follow up is performed and the workload is equally distributed.
- Review and approve contractual, administrative and legally unbillable adjustments in accordance with the policy.
- Stay 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.
- Stay current on the federal, state & local government regulations and the claim reimbursement & denials.
- Perform other related responsibilities to assist manager as required or requested.
- Bachelor's degree or higher is required.
- ADN degree required. A BSN degree can substitute for an ADN degree.
- RN Licensure required.
- 3 to 4 years of experience in insurance/denials is required
- Two years of experience beyond 4 years can substitute for the Associates degree.
- 40 hours per week
- Remote: Monday - Friday (8 am - 5 pm)
- Required to work other hours based on operational demand needs
- Great Benefits
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
