Job Details

Job Purpose

The Client Manager - Denial Management will provide leadership to Denial Management leadership and their teams, including supervision of staff, reviewing of processes, and providing recommendations for improvement of operations. Goal is to meet or exceed DenialManagement KPI benchmarks and client specific KPI's. Maintain or exceed team productivity and quality standards. Work with Director to understand and communicate the root cause of denials and provide data to assist the client to implement effective processes to correct actions. In this position, the Manager assists with recruiting, interviewing, and orienting new employees, monitoring and evaluating staff performance, and ensuring all employees have the tools and training for optimal productivity.

Duties and Responsibilities

• Provide management and supervision related to educating and training staff, evaluating staff performance and monitoring productivity
• Interview, hire, train, evaluate, and develop staff where applicable
• Develop and maintain quality control programs, including in-depth and individual performance reviews
• Orient new hires and provide in-services and training, continuing education, and development related to those functional areas of responsibility
• Plan, organize and direct overall operations of the Denial Management team assigned as it relates to appeals and follow up
• Work in conjunction with Director, Client Management, to set and manage target performance levels
• Actively engage with client(s) to understand needs and deliverables with the goal of creating a true partnership
• Ensure that team stays current with client requirements and industry requirements and/or trends
• Maintain an overall objective of high overturn rates, minimization of inventory and accurate client reporting
• Actively engage with and manage Denial Management team, including routine productivity and quality reviews
• Assure that team is meeting follow up quality and productivity standards
• Identify denial trends, including overturn rates, and make recommendations
• Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Qualifications

• Bachelor's degree or equivalent combination of education and experience
• 3+ years' experience managing and leading at a supervisory level or the equivalent
• Ability to work well individually and in a team environment
• Must be reliable, responsible, goal oriented and flexible
• Results driven
• Excellent interpersonal, communication and organizational skills
• High degree of integrity including ability to successfully deal with sensitive or confidential information
• Ability to exhibit poise, composure and confidence when confronting stressful or high pressure situations

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.