Manager of Appeals and Denials in Houston, Texas, United States
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HCA Houston Healthcare

Manager of Appeals and Denials

Houston, TX, United States
Full-time • No Weekends
Directors and Managers   Job ID: 02660-137117
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Description

SHIFT: No Weekends
SCHEDULE: Full-time


Do you have the career opportunities you want in your current role? We have an exciting opportunity for you to join the nation's largest provider of healthcare services as a Manager of Appeals and Denials.

We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.

Gulf Coast Division Office - Houston, Texas

Manager of Appeals and Denials – Quality Improvement

Serving patients throughout Greater Houston and South Texas, HCA Gulf Coast Division offers comprehensive health solutions—including advanced medical care, education, and community outreach—at its ten hospitals and other free-standing facilities. This network model gives our patients access to a circle of care that is unrivaled in the region. From simple outpatient procedures to complex surgeries performed by specialists, HCA Gulf Coast Division offers comprehensive care close to home.

Serving such a large and diverse region requires HCA Gulf Coast Division to offer a range of programs that meets the needs of young and old, acutely ill and chronically ill. Just some of our services and outreach efforts:

What you will do in this role:

  • Conducts Case Management compliance trend analyses from system reports, identifies gaps, and develops program components to mitigate identified gaps
  • Conducts appeal and denial reviews and trend analysis from various sources, such as audit reports, RAC/MAC trackers, and other appeal and denial information to assist in revising the appeal and denial processes to ensure optimum patient outcomes with appropriate utilization of services
  • Provides ongoing evaluation and assessment of Facility practices and industry changes to ensure the enterprise remains current in processes related to appeals and denials
  • Provides daily support and subject matter expertise to Facility and Division leadership, and identifies areas of opportunity for continuous improvement including ongoing education and resources as needed
  • Partners with Division Managed Care Department to engage with different payors to provide feedback regarding trends and issues.  Assures compliance of payors to regulatory guidelines
  • Engages with individual facilities to identify unique concerns and assists with development of action plans
  • Conducts ongoing research to remain current in evidence-based best practices
  • Maintains and articulates current knowledge and understanding of all corporate policies and procedures related to job function
  • Performs other duties as assigned

Qualifications

 

What qualification you will need:

  • Master’s degree in Healthcare, Management or related field required
  • Denials and Appeals Management experience required
  • Analytical skill set and experience required
  • General working knowledge of medical necessity criteria
  • In-depth knowledge of Denials Prevention
  • Current working knowledge of non-governmental and government payers and contractual language
  • Knowledge and understanding of government and Payor rules & regulations
  • Proficient with Excel and Microsoft Office Suite software
  • Ability to communicate effectively in oral, written and electronic formats
  • Ability to establish and maintain collaborative and effective working relationships with a focus on the importance of teamwork
  • Demonstrates leadership skills which model analytical and critical thinking abilities, problem resolution, proactive decision-making, negotiation skills, consensus building, and effective resource utilization

HCA Healthcare ranks on Fortune’s list of Most Admired Companies for three consecutive years and HCA ranks 63rd on the fortune 500 list. In addition Ethisphere named HCA as one of the World’s Most Ethical Companies. We want you to join our tradition of excellence. Intrigued? We’d love to hear from you.

If you find this opportunity compelling, we encourage you to apply. We promptly review all applications. If you are highly qualified you will hear from one of our recruiters.  We are actively interviewing so apply today!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Notice

Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.

For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.

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Details

Directors and Managers
Full-time • No Weekends

COVID-19 Vaccination

In compliance with the emergency regulation issued by the Centers for Medicare & Medicaid Services (CMS) dated November 4, 2021, and company policy, this role MAY require you to have received the first dose of a two-dose COVID-19 vaccination series (or a one-dose COVID-19 vaccination) by December 6, 2021, or to have applied for a medical or religious exemption. (For further clarification, please ask your recruiter.)

About HCA Healthcare

What matters most to our diverse and talented colleagues is giving people the absolute best healthcare in the most compassionate way possible.

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For questions about your job application or this site, please contact;
HCAhrAnswers at 1-844-422-5627 option 1.

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