Director, Enterprise Denials Management

Be inspired. Be valued. Belong. 

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.  We provide:

• Comprehensive health benefits that start day 1
• Student Loan Repayment Assistance & Reimbursement Programs
• Family-focused benefits
• Wellness incentives

Ongoing mentorship, development, leadership programs...and more!

The Director of Enterprise Denial Management is responsible for leading and managing the organization's denial management operations to optimize revenue recovery and ensure compliance with regulatory standards.

This role involves strategic planning, process improvement, and collaboration with various departments to minimize claim denials and enhance overall financial performance.

Strategic Planning:

• Develop and implement comprehensive denial management strategies to reduce claim denials and improve revenue cycle efficiency.

Operational Oversight:

• Oversee daily operations of the denial management team, ensuring adherence to established policies and procedures. Process Improvement
• Analyze denial trends to identify root causes and implement corrective actions to prevent future occurrences.

Regulatory Compliance:

• Ensure all denial management activities comply with federal, state, and payer-specific regulations.

Cross-functional Collaboration:

• Work closely with departments such as Billing, Coding, and Case Management to streamline processes and improve communication.

Staff Development:

Lead, mentor, and develop staff to enhance performance and foster professional growth.

Reporting and Analysis:

• Prepare and present regular reports on denial rates, recovery efforts, and process improvements to senior leadership.

Stakeholder Communication:

• Prepare and deliver reports and presentations on denial trends, financial impact, and process improvements to senior leadership and cross-functional teams.
  
  Minimum Qualifications:
• Education: Bachelor's degree in Healthcare or Business Administration, Data Analytics or a related field is preferred.
• Alternatively, 10 years of experience in healthcare revenue cycle management may be substituted for the educational requirement.
• Experience: A minimum of 8 years in healthcare revenue cycle management, with at least 5 years in a leadership role focusing on denial management.
• Strong analytical, problem-solving, and communication skills. Proficiency in healthcare billing systems.
• Licensure / Certifications: Epic Revenue Cycle Certifications and/or Certified Revenue Cycle Executive (CRCE) or similar certification is preferred.

This position is 100% remote, offering flexibility in work location. - The role requires occasional travel for training and meetings.

Supporting a diverse, equitable and inclusive culture.  Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status. EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law. EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals. EHC aspires to create an environment of collaboration and true belonging for all our patients and team members.  Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training.

ACCOMODATIONS: EHC will provide reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Diversity, Equity, and Inclusion.”

PHYSICAL REQUIREMENTS: (Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.