Associate Manager RN Denials Management

Headquartered in Arizona, Banner Health is one of the largest nonprofit health care systems in the country. The system owns and operates 33 acute-care hospitals, Banner Health Network, Banner – University Medicine, academic and employed physician groups, long-term care centers, outpatient surgery centers and an array of other services; including Banner Urgent Care, family clinics, home care and hospice services, pharmacies and a nursing registry. Banner Health is in six states: Arizona, California, Colorado, Nebraska, Nevada and Wyoming.

$37.14 - $61.90 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Innovation and highly trained staff. Banner Health recently earned Great Place To Work® Certification™. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we’re constantly improving to make Banner Health the best place to work and receive care. As an Associate Manager of RN Denials Management, you will be an integral part of leadership within the team. During your typical duties, you will have the opportunity to educate and develop team members, roll out process changes and projects, as well as troubleshooting questions from your team and outside stakeholders, and conducting review of findings. In this role you will have 10-12 direct reports who will be working centralized denials management for our 31 Banner facilities. A typical day would include overseeing RN denials mgt specialists and Audit team, posting bill reviews, and managing workflow and queue designation. The team is very independent and work remotely. Location: Remote, Banner supplies equipment Schedule: Exempt, Mon-Fri 8am-4:30pm AZ Time (No Weekends or Call) Position Summary: This position provides leadership, direction and support in response to denials from federal, state and commercial reimbursement programs. Provides leadership in clinical, financial, and personnel management within the department to result in overall reduction in payer clinical denials. Collaborates with Care Coordination, physician, Utilization Review, and other internal/external departments to overturn and/or reduction of payer denials. Reviews internal department practices and standards with staff to ensure maximum reimbursement while ensuring the provision of high quality, safe, and cost effective patient care. Demonstrates account denial and appeal review expertise and oversees the leadership of clinical, financial, and personnel management of the assigned department. This position supervises employees and participates in selection, orientation, counseling, evaluation and staff scheduling. Maintains clinical, leadership and post-acute care services knowledge and competency to evaluate denial and/or appeal outcomes related to delivery of clinical services.

Oversees the operations of the team to ensure smooth and efficient payer denial and/or appeal review. Assures appropriate team assignments. Completes daily rounding on team members to ensure quality reviews of payer denials and/or appeals. Accurately and thoroughly completes documentation required for claims payment of services approved through concurrent review Supervises the team to ensure internal/external client and employee satisfaction while promoting quality denial and/or appeal reviews and retention. Serves as a real-time resource and assists with clinical expertise for team members and physicians for problem-solving on various denials and/or appeals related patient services, processes, and specific denial issues. Identifies educational needs regarding payor issues, functions as preceptor, and provides appropriate education. Develops leadership skills among staff including communication, decision-making problem-solving/critical thinking and employee engagement. Leads the development of staff and supports career advancement opportunities. Functions as a role model and encourages staff to participate in their own development. Responsible for selection, orientation, on-boarding, and retention. Demonstrates leadership through coaching, performance evaluations, corrective actions, and development opportunities to create a culture of learning. Assists in the daily operational resource management including staff, approve/edit time cards, supplies, and equipment, and ensures optimal productivity for the department. Tracks, monitors and documents denial causes and resolutions with appropriate management staff. Builds and continually updates a knowledge of payer requirements for covered treatment protocols by diagnosis, approval requirements for procedures, and coverage norms.