Grow your career at Cedars-Sinai!At Cedars-Sinai, we're motivated by a collective spirit of innovation and the challenge to continuously improve. Above all, we share a real passion for helping others. Day after day, from department to department, our people give their all to create a community unlike any other. This is just one of the many reasons U.S. News & World Report has named us one of America’s Best Hospitals. Join us and make a difference every single day in service of this outstanding work – excellence and innovation in patient care, research, and community service. From working with a team of dedicated professionals to using state-of-the-art facilities, you’ll have great resources to do something incredible—for yourself, and for others.
What you will be doing in this role:
The Associate Director of Clinical Denials works closely with clinical department directors, senior management, physicians, vice presidents, and other key members of management independently to create and manage a program to appeal, overturn and collaborate to reduce clinical denials. Responsible for planning, implementing, directing, and controlling all workflows and special projects, working with payors, payor contracting and case management on overall problem solving and strategic initiatives relative to Clinical Denials Management Duties include:
- Directs all functions within clinical denials team. This includes methods to simplify, automate, and eliminate waste, while increasing cash, minimizing revenue leakage, and supporting the most compliant processes.
- Supports revenue cycle optimization by developing methods to effectively communicate information through presentations, reports, educational programs, memoranda, etc. and by providing formal and informal education to leaders and staff pursuant to reducing clinical denials and unnecessary lengths of stay.
- Provides leadership, guidance and effectively manages the day-to-day operations of the team, ensuring timely review, appeal and follow up.
- General knowledge of healthcare revenue cycle including familiarity with reimbursement methodologies, coding, CDM, charge capture, and billing processes
- Ensures compliance issues, their importance and consequences are handled in a timely and appropriate matter.
- Develops and maintains a budget in collaboration with VP of PRM. The budgeting includes but it not limited to, staffing (position control), salaries, equipment, supplies, facilities, etc., by analyzing department needs.
- Directs departmental activities by planning, analyzing, developing and implementing departmental programs, products, services, and/or strategies that, when integrated with overall hospital goals, ensure favorable hospital operating results.
- Directs the development and use of job descriptions and performance appraisals. Measures employee job performance throughout each year and delivers evaluations annually and as needed.
- Identifies and leverages opportunities to continually improve the quality of appeal and data management systems, processes and standards.
Requirements:
- Bachelor’s degree in nursing, healthcare finance, or related healthcare administration preferred.
- RN state license required upon hire.
- A minimum of 5 years of Revenue Cycle operations, billing / reimbursement, Internal Audit, or healthcare consulting. 10 years preferred.
Why work here?
Beyond outstanding employee benefits we take pride in hiring the best employees. Our accomplished and compassionate staff reflects the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation.
: 13329
Working Title : Associate Director, Clinical Appeals
Department : CSRC - Denials Med Necessity
Business Entity : Cedars-Sinai Medical Center
Job Category : Patient Financial Services
Job Specialty : Revenue Integrity
Overtime Status : EXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $134,586.80 - $236,872.00
