About the Company

Growing Healthcare System is Seeking a Proven Denials Management Leader. This system offers opportunities to advance, great benefits and Leadership that values innovative ideas.

About the Role

• Over staff of 10 knowledge of Medicare National Coverage Determinations (NCD) and Local Coverage Determination (LCD) protocols for medical necessity/Advanced Beneficiary Notice (ABN). Demonstrated knowledge of International Classification Determination Tenth Revision (ICD-10), Current Procedural Terminology (CPT), Diagnosis-Related Groups (DRG), Healthcare Common Procedural Coding System (HCPCS), and Revenue codes. Must know insurance rules and regulations including Medicare, Medicaid, Managed Care and Commercial Insurance.
• Must be familiar with Florida statutes as they pertain to managed care operations. Knowledge of managed care contracts and policies/procedures as well as overall operations.
• Ability in establishing and maintaining effective working relationships.
• Effectively analyze problems and consistently follow through to solution.
• Must take initiative and exercise independent judgment, decision-making, and problem solving expertise.
• Good oral and written communication skills at all levels.
• Must have demonstrated leadership skills and understanding of group processes, teamwork, and cost center based management.

Qualifications

• Bachelor's degree
• Require a minimum of ten (10) years of managed care, appeals/denials and/or reimbursement schedules experience, in which, five (5) years are in written appeals
• Required Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification by the American Health Information Management Association (AHIMA)
• Epic Experience