Director - Denials Management (Remote)

Director, Denials Management

Reporting to the VP, Patient Financial Services, the Director, Denials Management serves as the strategic leader and leads all denials prevention and management activities for the Stanford Health Care enterprise across hospital and physician revenue business lines. This role has oversight for the team management, operational performance, and continuous optimization of key Revenue Cycle multiple functions including denials follow-up, denials appeals, denial and write-off analysis, and denials prevention.

The Director operates as the enterprise expert and spokesperson for denials and write-off issues and serves as the lead of top line strategic initiatives to reduce and prevent denials and related financial losses.

Locations : Stanford Health Care

What You Will Do

Acts as Chair of Denial Prevention committee. Provides strategic direction and decision-making for denials prevention and management activities. Stewards the performance of critical KPIs related to denials performance, including initial denial rates, appeal success rates, and controllable write-off levels. Directs and prioritizes multiple enterprise strategic initiatives related to denials reduction and prevention. Approves and facilitates complex denials management operations and appropriately escalates operational risks. Continuously develops and manages the standard work of the management and prevention departments. Partners with other Revenue Cycle operational directors to ensure coordinated and optimized account management. Creates materials for and actively facilitates monthly Denials Prevention Task Force sessions. Represents the Revenue Cycle in organizational forums where denials issues are at the forefront. Delivers regular executive-level presentations on denials trends and performance to both financial and clinical audiences. Engages regularly and proactively with cross-functional stakeholders who impact denials performance. Influences senior executives in decision-making around denial prevention and mitigation strategies. Monitors and responds to internal / external market and payer trends that impact denials. Tracks and measures Denials Prevention program performance to determine effectiveness of prevention efforts on net revenue realization. Leads denial related discussion in payer relations meetings (JOCs) and forums to address issues and drive root-cause resolution. Provides feedback to Managed Care department regarding payor policies and payor contract terms that drive denial and write-off risk; coordinates the collection of data, operational and clinical feedback to respond to payor policy objections. Maintains expert-level knowledge of denials operational practices, federal and state payer regulations, and financial performance improvement methodologies. Develop and maintain pre-bill write-off policy and procedure based on root cause findings identified in the Denial Prevention Task Force workgroup efforts. Guide recurring audits and analysis of pre-bill write offs that would likely be denied for prevention tactics and execute denials prevention methodology against that population.

Education Qualifications

Bachelor's degree in healthcare administration, finance or business or related field Required. Master's degree in healthcare administration, finance, business, or related field Preferred.

Experience Qualifications

Ten (10) years of progressively responsible experience in the field of denials prevention and management OR Master's degree in healthcare administration, finance, business, or related field with seven (7) years of progressively responsible experience in the field of denials prevention and management.

Required Knowledge, Skills and Abilities

Knowledge of denials management and insurance account resolution best practices. Knowledge of Revenue Cycle functions and workflows (front, middle, and back) and their impact on denials prevention. Knowledge of data analytics techniques and best practices. Knowledge of performance improvement methodologies. Ability to foster effective working relationships and build consensus. Ability to communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, conflict resolution, consulting and advising. Ability to draft compelling and level-appropriate written communications. Ability to effectively present complex issues to internal and external customers. Ability to plan, organize, motivate, mentor, direct and evaluate the work of others. Strong ability to lead initiatives and influence leaders overseeing operations that are based within and outside revenue cycle. Ability to provide leadership and influence others. Ability to develop long-range business plans and strategy. Ability to assess and evaluate complex financial data. Strong transformation skills and ability to drive change in a fast-paced organization.

Physical Demands and Work Conditions

Blood Borne Pathogens Category III - Tasks that involve NO exposure to blood, body fluids or tissues, and Category I tasks that are not a condition of employment.

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family's perspective :

• Know Me : Anticipate my needs and status to deliver effective care
• Show Me the Way : Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me : Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and / or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale : Generally starting at $89.01 - $117.94 per hour. The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training.