Lead-Denial Mitigation

The Denial Mitigation Lead will assist the Denial Mitigation Supervisor and/or Manager in daily operations and work flow of the Denial Mitigation Department leading the work Financial Counselors, Authorization/Appeal Specialists, Denial Specialists and Denial Analyst to ensure that financial applications, authorizations, appeals, and/or correspondence are processed in a timely manner in accordance with BMHCC and/or the payer’s policies and procedures. This work encompasses all oncology infusion, radiation oncology clinics across multiple clinical oncology sites, and/or all BMHCC hospitals.

The Lead will assist the Supervisor and/or Manager in collaboration with the overall clinical oncology and/or hospital departments, physicians and hospital revenue cycle departments to ensure that the staff meet the metrics, mission, vision,and values of the BMHCC organizations.

Assist Supervisor/Manager in overseeing work assignments of staff responsible for financial applications, authorization, appeals, correspondence for oncology services and/or hospital services across BMHCC.

• Assist in providing educational tools and continued education for the team as it relates to oncology drugs and/or outpatient services to meet medical necessity guidelines and obtain authorizations/appeals.
• Assist Supervisor/Manager with preparing information for staff meetings to keep staff informed of payer updates, workflow changes, and other information as appropriate.
• Responsible for monitoring all assigned work queues to ensure all timelines are met to obtain authorizations, file appeals, complete triage reviews and retros, and/or complete timely write-offs and reporting insufficiencies to the Supervisor/Manager.
• Coordinate with internal and external customers to assist Supervisor/Manager with identifying opportunities for improvement.
• Responsible for reporting any system issues, payer issues, or anything that impacts the department work, present suggestions for resolutions to supervisor/manager, and assist in implementing any changes.

Thorough knowledge of payer specific guidelines as it relates to oncology drugs and/or outpatient services and assist Supervisor/Manager in portal education of other team members.

• Contributes to a positive work climate and the overall team effort of the department.
• Conduct site visits for education of staff as needed for new hires and re-education.
• Ensures that customer satisfaction is achieved through courteous and effective communication, problem solving, and efficient processes.
• Maintains confidentiality in compliance with HIPPA regulations and ensures that department remains compliant with all relevant regulations.
• Works with internal and external customers to identify opportunities for improvement, which result in enhanced denial management services and customer satisfaction.
• Collaborates with Clinic Directors, as applicable and coords meetings/site visits as needed to develop workflows and address issues as they arise and provide direction on next steps.
• Research and collaborates with the Director Denial Mitigation in the resolution of treatment and services denied by Medicare, Medicaid, Tricare, commercial payers, and Managed Care organizations.
• Performs other duties as assigned and directed.

3-5 years of business experience in a healthcare environment with 3 of those years working in a hospital, physician office, revenue cycle, denial management, patient accounting, or payer environment performing activities such as correspondence processing, denials, appeals, billing, collections, registration, scheduling, medical record requests, payer follow-up, or administrative support.

5-7 years of business experience in a healthcare revenue cycle with at least 5 years in…