Offer summary

Qualifications:

Bachelor's degree in business, healthcare, or a related field, or equivalent experience., Seven years of experience in revenue cycle management, with five years in a leadership role., Strong management skills with an emphasis on team building and leadership., Ability to analyze complex denial processes and implement effective solutions..

Key responsibilities:

Direct and oversee denial activities within the revenue cycle areas.

Lead teams in identifying and correcting root causes of denied claims through process improvements.

Communicate findings related to denials and appeals to senior executives and key stakeholders.

Provide education on denial prevention and manage the redesign of denial management processes.

Job description

It's more than a career, it's a calling.

MO-REMOTE

Worker Type:

Regular

Job Highlights:

Additional Job Description

Named 150 Top Places to Work in Healthcare 2024 - Becker's Healthcare
Named One of the Diversity Leaders 2024 – Modern Healthcare
Named One of America's Greatest Workplaces for Diversity 2024 - Newsweek
Named One of America's Greatest Workplaces for Women 2024 – Newsweek
Named One of America’s Greatest Workplaces for Job Starters 2024 – Newsweek

SSM Health is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through a robust and fully integrated health care delivery system. The organization’s 40,000 team members and more than 13,900+ providers are committed to providing exceptional health care services and revealing God’s healing presence to everyone they serve.

With care delivery sites in Illinois, Missouri, Oklahoma, and Wisconsin, SSM Health includes 23 hospitals, more than 300 physician offices and other outpatient and virtual care services, 12 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, a health insurance company and an accountable care organization. It is one of the largest employers in every community it serves.

This position IS remote work eligible. SSM Health currently offers remote work within the states of MO, WI, IL, OK, AL, FL, GA, IA, IN, KS, KY, LA, MI, NC, SC, TN, TX, UT, VA, WV.

To request additional information, confidentially submit your interest, or nominate a fellow colleague, please contact:

Angela Jones
Executive Talent Partner
Angela.Jones1@ssmhealth.com

#LI-Remote

Job Summary:

Directs, coordinates and oversees denial activities within the Hospital or Medical Group revenue cycle areas. The scope of responsibility is all post-billed denials (inclusive of clinical denials). Engages with key leadership including regional leaders to identify and correct root cause of denied claims through process improvements, set goals, measure process effectiveness and identify any need for policy and procedure updates.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

Directs managers and team responsible for identifying denial and disputed payment process breakdowns. Creates a culture in alignment with mission and values, fostering individual motivation, teamwork and high levels of performance and accountability utilizing a participative management style to ensure staff retention and engagement.
Understands complexities involved in supporting denials activities spanning multiple states, regional health ministries, payer environments, and technologies to direct teams accordingly to achieve high performance and resolution on trends.
Demonstrates strong management skills that emphasize team building and strong leadership with the ability to provide clear direction to the department, while also functioning as an individual contributor to achieve goals. Lead projects to improve denial claim performance, compliance and efficiency within the denials process and structures. Identifies action plans to improve the quality of services in a cost-efficient manner and facilitates plan implementation.
Leads the team in identifying and correcting root cause of denied claims through process improvement.
Oversees communication and follow-up processes related to denials and appeals to ensure such activities are submitted timely, tracked, trended and reported to key stakeholders.
Serves as a liaison to members of the medical staff and other regional colleagues, regarding denial management processes, systems and requirements.
Leads the redesign of denial management processes and systems to improve service, data integrity, and staff productivity/quality to achieve departmental goals and process outcomes.
Provides education to departments regarding denials prevention and appeal success rates.
Coordinates with Health Information Management and Case Management leadership on con-current denials. Review denial data appeals and under payment issues and/or revenue opportunities; report the revenue impact differential for issues identified, implemented, or corrected.
Reports financial impact of denials; communicates findings to senior executives as needed.
Performs other duties as assigned.

EDUCATION

Bachelor's degree in business, healthcare or related field, or equivalent years of experience and education

EXPERIENCE

Seven years' experience, with five years in leadership

Department:

8701330033 Revenue Cycle Denial Operations

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.

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SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.

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