Senior Director, Denials

Summary

Join EnableComp as a Senior Director, Denials and lead the daily oversight and growth of the Revenue Services Department. Provide leadership and coaching to a team of people leaders, developing and implementing a comprehensive denials/appeals management program. Serve as a subject matter expert in denials, evaluating strategic and operational development of denials products to enhance the company's competitive strategy. Develop and outline department process improvements and training to ensure efficient operation, financial stability, and growth. Manage and lead denials-based projects for multiple clients, forecasting accurate monthly revenue projections. Manage all aspects of client projects, including client communication, risk management, issue resolution, and identifying opportunities for high client satisfaction and revenue maximization. This role requires successful management of project plans, resources, and clients.

Requirements

• Bachelor’s Degree preferred
• Highschool diploma or GED required
• Provide strategic direction and leadership to ensure the team meets client expectations
• 10+ years’ experience in management or supervisory experience
• 8+ years’ experience in healthcare field working
• 7+ years’ of client facing/customer services experience
• Comfortable understanding of insurance payer/provider claims processing
• Equivalent combination of education and experience will be considered
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions
• Load-balance departmental duties to establish the correct allocation of resources and accurate measurement of deliverables and program operational goals
• Maximize efficiency and productivity through extensive process analysis and interdepartmental collaboration
• Manage multiple teams by setting daily, monthly and strategic goals for assigned supervisors/managers
• Ensure compliance and consistency with regulations and internal policies
• Identify why/when/how to make up variances on best practice metrics, and report variances and action plans to Executive Management on a weekly basis
• Maintain a current working knowledge of all related HIPAA regulations and ensures staff compliance to these requirements. This includes updating work processes, system capabilities, and policies and procedures as well as training staff on these requirements
• Perform regular audits and client reviews ensuring EC is delivering all requirements to the satisfaction of the client
• Strong working knowledge of data analysis and performance metrics using business management software
• Extensive level of understanding of insurance payer/provider claim processing and subsequent data requirements
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook)
• Regular and predictable attendance
• Travel 10-15%; general office environment

Responsibilities

• Acts as a subject matter expert in EnableComp Denials related products
• Conduct product opportunity research to determine efficacy and profitability based on cost models
• Research and development of innovative products enabling EC to advance within the industry, increase profitability, and grow as a company
• Act as a key resource during the implementation of the new products
• Identify, research, and develop new business opportunities within the scope of the department
• Assist with department’s business strategy alongside the Vice President, Complex Claims
• Create and manage training materials and presentations to support departmental growth, best practices, and increased revenue
• Participate and lead aspects of product implementations while identifying improvements and opportunities
• Develop or enhance operational processes within the Denials Department to drive efficiency with focus on quality
• Assist with the creation, communication, and training of new department products, process changes, and operational best practices
• Create, define, and modify processes for general client denials inventory and performance management, communication, reconciliation processes, and client/executive denials reporting
• Manage a team of CC Project Coordinators, responsible for hiring and staffing of this department as business needs dictate
• Work closely with Analytics team to analyze incoming files for data integrity, revenue opportunity, and client feedback
• Assist Implementation team with implementation/client onboarding, team member access related issues, and new client or product related projects
• Communicate with EC team members to identify and define denial project related requirements and scope
• Responsible for organizing and tracking escalated issues, including communicating action plans for resolution with senior management stakeholders and senior leadership at EnableComp
• Act as liaison between Client and department for special projects, issue resolution, and any other client or department needs
• Manage a portfolio of Client Project Dashboards, issue resolution, action plans and related processes
• Lead Client performance reviews, quarterly business reviews, and related performance-based meetings via teleconference and/or onsite directly with decisionmaker-level executives
• Other duties as assigned

Preferred Qualifications

• Practices and adheres to EnableComp’s Core Values, Vision and Mission
• Proven ability to meet and/or exceed productivity targets and goals
• Maintains stable performance under pressure or opposition.Handles stress in ways to maintain relationshipswith all stakeholders
• Proven success in setting priorities for direct reports
• Must be a self-starter and able to work independently without direct supervision
• Proven written and verbal communication skills
• Strong analytical and problem-solving skills
• Proven experience working with external clients; strong customer service skills and business acumen
• Ability to prioritize and manage multiple competing priorities and projects concurrently
• Must be able to remain in stationary position50% of the time
• Occasionally moves about inside the office to access office equipment, etc
• Constantly operates a computer and other office equipment such as a copy/scan/print machine, phone and computer