What are the responsibilities and job description for the Medical director position at Pathnostics - A Diagnostics Solutions Company?
The Director of Medical Appeals and Collections is responsible for developing and managing the appeals resolution process in order to increase revenue and minimize denials.
This role focuses primarily on appealing denials, obtaining the status of submitted appeals, Quality Assurance, and gathering and reporting insights and best practices to make improvements.
This role will collaborate with Payer Relations on managing and responding to Payer Audits. Additionally, this role has oversight of claim prior authorization, appeals, and collections team processes.
Primary Responsibilities :
- Developing Appeals strategy and processes
- Managing Appeals and Collections teams
- Investigating & resolving claim denials
- Initiate and resolve appeals for various payers
- Managing claims collections, provide customer service to resolve issues
- Communicating internally and with external customers to ensure timely review / resolution
- Identifying trends and / or root cause of issues, and proposing solutions
- Provide guidance and training to other collections team members
- Resolve insurance discrepancies and short payments
- Creation and management of spreadsheets to track key performance metrics
- Create and / or revise Standard Operating Procedures for the Collections & Appeals team
- Collaborate with Payer Relations on responding to payer audits
- Other duties as assigned by management
Educational and work experience requirements
- Bachelor’s degree or equivalent experience is preferred
- 5 years of Medical Appeals and Collections experience ideally in laboratory proprietary testing environment
- Management experience
- Clinical experience is preferred (ability to perform clinical chart review / abstract information efficiently) but not required
Essential Skills / Abilities
- Excellent written, interpersonal communication & negotiation skills
- Excellent Excel, Access skills
- Python data development or similar
NOTE : The ideal candidate for this role can report to our Irvine office daily for work, however, we will consider hybrid candidates with exceptional experience and qualifications for the role.
Pathnostics is proud to be an equal opportunity employer. We are an E-Verify participating employer.
Benefits :Schedule :
Monday to Friday
Ability to commute / relocate :
Irvine, CA 92618 : Reliably commute or planning to relocate before starting work (Preferred)
Experience :
- Medical Appeals : 4 years (Required)
- Medical collection : 4 years (Required)
- Team leadership (2 years)
Last updated : 2024-11-07