Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California.

  • Job Objective: A brief overview of the position.
    • Works under the direction of the Director, Payor Relations to actively execute the direction of the Denial Analytics Department by developing staff and managing relationships with Revenue Cycle stakeholders. Responsible for displaying behavior that promotes accountability for performance of job tasks. Ensures a positive work environment, acting as a resource to staff, in performing their job responsibilities. As a Denials Analytics Manager, you will be responsible for managing all activities related to monitoring and appealing denials received from Third Party Payers, including providing root cause analysis on prevalent denials issues to support front end process improvements.

  • Reports to
    • Director, Payor Relations

  • Supervises
    • Denials Analysts

  • Ages of Patients
    • N/A

  • Blood Borne Pathogens
    • Minimal/ No Potential

  • Qualifications
    • Education
      • Required: Bachelor’s degree

    • Licensure/Certification
      • N/A

    • Experience
      • Required: 5+ years’ experience in a hospital PFS, Collection Agency, Revenue Cycle or Payer setting. 3+ years’ leadership experience in claims, denials, revenue cycle environment. Proficient in running advanced reporting in Epic. Intermediate to advanced understanding of medical & managed care terminology, hospital or clinic revenue cycle, contracting, CPT and ICD-10 coding, as well as accounting principles. Understanding of CMS guidelines and coverage determinations. Advanced understanding of facility, as well as professional claims billing practices.

         

  • Essential Responsibilities
    • Demonstrates compliance with Code of Conduct and compliance policies, and takes action   to resolve compliance questions or concerns and report suspected violations.
    • Responsible for the accurate and timely resolution efforts of the Denials team for inpatient, outpatient and ancillary 3rd party claims (professional and facility claims).
    • Facilitate payor escalation efforts with health plans to resolve denial issues.
    • Run monthly reporting pertaining to top denial and underpayment issues to be distributed out to relevant clinic or Revenue Cycle departments.
    • Facilitate denial meetings among relevant Revenue Cycle Stakeholders one a monthly basis to share insights and promote process improvements to mitigate denials. Effectively communicate and work with internal departments to implement work flow improvements (where necessary) that promote efficiency and mitigate denials on the beck end.
    • Serve as Managed Care Liaison and manage contract issues in relation to payment variance and denials.
    • Review and approve manual adjustments and forward to Director if adjustment is greater than $10,000.
    • Responsible for quality and performance metrics of processing team. Maintain regular productivity logs for each member of the Denial Analyst staff, providing them with monthly data on their successes and identifying any areas of needed improvement.
    • Guides Denials team strategic plan through thorough reporting, assessment of priorities and engagement of stakeholders.
    • Conduct regular staff meeting to provide feedback on unit operations, discuss problematic issues and introduce new procedures and/or regulations.
    • Provide/facilitate regular and ongoing staff training as needed by individual staff and on a routine and ongoing basis to ensure optimal skill levels and a current knowledge base for all employees.
    • Complete evaluation process for Denials staff.
    • Arrange for desk coverage when an employee is absent more than one day.
    • Identify problems, recommend and facilitate procedural changes when appropriate.
    • Assist in the development of Denials team policies and procedures.
    • Perform special projects and attend meetings as requested by Director.
    • Participate in the interview and hiring process to ensure adequate Denials team staffing
    • Maintain staff time and attendance records as required.
    • Counsel staff regarding performance deficiencies and give verbal and written disciplinary warnings under the direction of the Director.
    • Monitor and control budget items that directly affect unit’s responsibility
    • Attends staff meeting, in-house training and attend classes pertaining to Federal and State billing regulations as well as compliance issues and Guidelines, when requested.
    • Perform other job-related tasks as assigned by Director.

Eisenhower Health offers generous benefits package and matched retirement plan.

Effective immediately upon hire, all employees are eligible to participate in a benefits program designed to make a difference for you and your family.

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A Culture of Positivity and Support

From the beginning, this organization formed a culture based on strong values, commitments and a passion for service and professional excellence.

What Our Nurses Say

One of my very favorite things about working at Eisenhower Health is the culture on inclusivity that we have and a strong base for evidence-based practice.

Lori

Neonatal Nurse

One of the greatest things about working as a nurse at Eisenhower Health is how much support you get from Administration. We keep on improving the process here. It's a fantastic place to work.

Richard

Nursing Supervisor

My favorite thing about working at Eisenhower Health is the camaraderie within my unit and with the different departments.

Jennifer

Registered Nurse

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