Denials And Appeals PFS Supervisor

If you care about the opportunity to grow, to make a difference, to build a future and a life, then we just might have the career for you. Care to talk?

Bayhealth Medical Center is Central and Southern Delaware's healthcare leader with hospitals in Dover and Milford, as well as stand-alone Emergency Department in Smyrna and a hybrid Emergency Department and Urgent Care in Milton. We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore. Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand!

Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:

• Generous Paid Time Off and Paid Holidays
• Matching 401(k)/403(b) Plans
• Excellent Health, Dental, and Vision
• Disability and Life Insurance options
• On Site Child Care
• Educational Reimbursement
• Health Care and Dependent Care Flex Spending Accounts
• Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

Location: 30 Old Rudnick Ln

Status: Full Time 80 Hours

Shift: Days

SALARY RANGE: 57,553.60 - 86,320.00 YEARLY

General Summary:

Patient Financial Services (PFS) Supervisor, Denials & Appeals manages the daily operations, staff, and regulatory compliance of appeal teams to resolve denied medical claims. The ideal candidate is an agent for change who manages workflows in an agile manner to adapt to regulatory and payer policy changes real time. They ensure adherence to CMS, state, and payer regulations, analyze denial trends to reduce risks, and handle complex cases maximizing legitimate reimbursement. Common responsibilities include training staff, monitoring productivity, and collaborating with clinical, legal teams, and other pillar teams as necessary.

Responsibilities:

1. Monitor daily workflow, manage inventory levels, and ensure cases are resolved within mandated regulatory and/or payer contracted timeframes (e.g., Medicare Advantage, CMS, DOH). Review A/R analysis and all high dollar accounts with balances greater than $25,000; document the review in the account notes. Monitor denied losses for PFS. Identify challenges/barriers to timely filing and implement change needed to minimize timely filing denials. Distributes productivity and denial reports by status code to team members and PFS Leadership.

2. Assigns and prioritizes work, sets goals, and coordinates daily activities of the team. Recruit, train, coach, and supervise appeal specialists and other team members, setting productivity and quality goals. Ensures unpaid/lengthy appeals are escalated to the Department of Insurance, CMS or Delaware Medicaid program as appropriate per PFS Leadership expectations. Provides regular updates and communication to staff through 1:1 and team meetings.

3. Analyzes all denials trends, identifies root causes, develops corrective action plans and improvements for revenue cycle functions. Ensures denial reporting tool is current on all data files and team members are using the tool to enable accurate analysis and reporting in real time and at month end.

4. Review appeals for accuracy, maintain audit readiness for state/federal audits, and update policies, procedures, and desktop manuals.

5. Complete monthly rounding on direct reports; maintain individual rounding logs and stop light reports to facilitate communication.

6. Serve as a subject matter expert, partnering with internal departments (e.g., Provider Relations, Legal, Utilization Management) and external entities, such as insurance carriers.

7. Monitor performance by outside contractor within Bayhealth's performance expectations.

8. Reviews quality assurance review results with staff providing as necessary education/training to address opportunities for improvement. Contributes to development of education materials for new hire and annual training competencies. Perform quality assurance in absence of department trainer.

9. Reviews all requests for system changes to determine the impact on payers and processes under the position's span of control. Ensures supporting research and documentation supporting the change request are accurate and have been properly validated.

10. AII other duties as assigned within the scope and range of job responsibilities.

Required Education, Credential(s) and Experience:

• Education: High School Diploma or GED

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• Credential(s): None Required

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• Experience:

Required: Five years of hospital A/R or patient accounting experience at Bayhealth.

Preferred: Lead or Supervisory experience.

Preferred Education, Credential(s) and Experience:

• Education: Associate Degree

Related field

• Credential(s): Certified Professional Coder

Certified Professional Compliance Officer

• Experience:

To view a full list of all open position at Bayhealth, please visit:

https://apply.bayhealth.org/join/