MGR - APPEALS

Responsibilities

Western Region CBO

The Western Region Consolidated Business Office provides business office services including billing, collections, cash posting, pre-access management, variance and customer service to our affiliated UHS facilities. We are seeking dynamic and talented individuals to join our team.

Job Description :

The primary responsibility of the Appeals-Denials Manager is to receive, investigate, and manage all appeals, provider disputes, and member complaints relating to technical and clinical issues identified during the billing and payment of claims. Manages staff and the appeals workflow to assure effective and efficient resolution to claims. The position will provide resolution of the grievance situations in compliance with legal and regulatory requirements. Is a key liaison to the facilities in providing information on denials and process improvements to reduce the number and amount of denials.

Qualifications

Education :

Associates or Bachelors degree in Nursing or CPC, CPC-H or CCS certification required.

Experience :

Extensive knowledge of medical records is required. Experience working in case management and with technical denials is required.

Other :

The ability to communicate clearly and concisely both verbally and in writing. Possess a complete knowledge of state and federal regulations and requirements for effective and efficient collections. Able to conduct clinical or compliance audits for the purpose of validating regulatory compliance. Customer focused, providing service consistently exceeding expectations to both internal and external customers.

Technical Skills :

Computer proficiency to include work processing, spreadsheet, database, and patient accounting system. Excellent Customer Service skills required as well as good written / oral communication skills.

This opportunity offers the following :

• Challenging and rewarding work environment
• Growth and Development Opportunities within UHS and its Subsidiaries
• Competitive Compensation
• Excellent Medical, Dental, Vision and Prescription Drug Plan
• 401k plan with company match

UHS is one of the nation's largest and most respected hospital companies; Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. In 2017, UHS was recognized as one of the World's Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies.

Our operating philosophy is as effective today as it was 40 years ago : Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve.

Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom.

UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via-email, the Internet or in any form and / or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.