All the benefits and perks you need for you and your family:

• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Monday- Friday Fulltime

Job Location : Remote

The role you will contribute:

Responsible for planning, managing, and evaluating daily denials management functions, including appeals, billing, payments, customer service, and audit responses. This position ensures the future growth and development of the Denial Management Team in accordance with professional standards, procedures, internal policies, and regulatory requirements. This role meets or exceeds financial and operational metrics, minimizes errors and claim denials, and maintains quality assurance processes. In addition, this position serves as a centralized resource for billing and compliance integrity and provides direction to staff across various regions and facilities. Ensures collaboration with other departments and agencies, participates in strategic planning, and identifies opportunities for process improvement.

The value you will bring to the team:

• Directs audits and manages denials to minimize errors, rejections, and avoidable denials.
• Ensures follow-up and denial management activities align with standards, policies, guidelines, training, and practices.
• Analyzes data to identify root causes of denials and implements process improvements to prevent repeated errors.
• Collaborates with Revenue Cycle stakeholders to facilitate data sharing and maximize claims reimbursement.
• Monitors and reviews team performance for timeliness, productivity, and quality standards.
• Sets annual departmental goals and provides direction based on organizational standards.
• Resolves problems, including HR issues, and allocates resources effectively.
• Staffs, trains, and mentors team members to ensure high performance.
• Maintains and updates procedures to align with best practices and regulatory requirements.
• Approves staffing realignment and performance appraisals based on supervisors' and director's recommendations.
• Ensures timely, accurate, and comprehensive documentation of all claim activities.
• Serves as a liaison between multiple Revenue Cycle Departments, including Consumer Access, Patient Financial Services, Managed Care, and Revenue Integrity.
• Other duties as assigned.

The expertise and experiences you'll need to succeed:

• Bachelor's degree Required
• 3 Work Experience Required
• Analyze, track, trend and escalate issues as needed in order to facilitate optimal revenue recovery
• 3 Leadership Experience Required
• Ingenuity and judgment are required to review facts, plan work, estimate costs, interpret results, draw conclusions, and take or recommend action
• Self-starter with the ability to work under limited day-to-day oversight
• Strong supervisor/management skills, providing clear performance expectations as well as evaluating/resolving performance problems.
• Time management proficient
• Critical thinking and analytical skills
• Proactive
• Results driven
• Strong attention to detail
• Ability to work in a project-oriented environment with people of various background
• Ability to work in a fast-paced dynamic environment and meet deadlines
• Comfortable providing group presentations
• Strong understanding of payer reimbursement and denial functions related to all payers including but not limited to Managed Care/Commercial, Managed Medicare, Medicaid, Medicaid HMO products and Government (i.e. VA and Tricare),
• Understanding of the application and interpretation of contract language and rates.
• Uses discretion when discussing personnel/patient related issues that are confidential in nature
• Effective oral and written communication skills, with the ability to articulate complex information to all levels of colleagues
• Proficiency in Microsoft Suite applications, specifically Excel, Word, and PowerPoint applications, as well as Outlook
• Strong organizational skills
• Strong keyboard and 10 key skills
• Proficiency with medical billing and remittance forms and processes, including 835 and 837 files, and UB04 and CMS-1500 (HCFA) forms
• Understanding of PFS registration and billing processes
• CPAM, FHFMA, or CHFP
• Certified Revenue Cycle Representative (CRCR)

Preferred Qualifications:

• Master's degree Preferred

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Patient Financial Services

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 25041476

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.