Job Information
MetroHealth Manager Denials-AR Management (Hosp) in CLEVELAND, Ohio
Location: METROHEALTH MEDICAL CENTER
Biweekly Hours: 80.00
Shift: 8am - 4:30pm
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County’s safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.
Summary:
Oversees and manages the hospital and professional denials resolution process within MetroHealth. Analyzes and identifies root causes of denials through targeted account review or sampling. Develops strategies to proactively minimize denials while monitoring and reporting denial trends. Works collaboratively with various stakeholders, including Revenue Cycle leadership, other MetroHealth departments, clinicians, coders, vendors, and payers to streamline processes, improve reimbursement outcomes and maintain compliance with billing and regulatory requirements. Utilizes strong knowledge of industry practices related to healthcare clinical and administrative systems such as billing, coding, follow-up, denials management, exceptional analytical skills, and the ability to navigate complex payer guidelines and contracts.
Qualifications:
Qualifications: Required: Bachelor’s degree in healthcare administration, business, or a related field. 3 years of experience in Healthcare Denials Management, claims processing, or healthcare administration, preferably in a leadership or managerial role. Previous experience working with and knowledge of payer portals. Proficiency in using denials management software, electronic health record (EHR) systems, and revenue cycle management tools. Intermediate proficiency in medical terminology. Advanced expertise of the Microsoft Office Suite. Strong problem solving, conflict-resolution, and decision-making skills. Strong written, communication, and presentation skills. Ability to prioritize work, meet deadlines, and produce quality results on time with strong attention to detail.
Preferred: Master’s degree in healthcare administration, Business, or a related field. Professional certifications, such as Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), or Certified Revenue Cycle Professional (CRCP). Intermediate proficiency in using EPIC, including Denials Management-related reporting and Slicer Dicer. Familiarity with data analysis and reporting tools, such as Microsoft Excel or Tableau.
Physical Demands: May need to move around intermittently during the day, including sitting, standing, stooping, bending, and ambulating. May need to remain still for extended periods, including sitting and standing. Ability to communicate in face-to-face, phone, email, and other communications. Ability to read job related documents. Ability to use computer.