PRIMARY RESPONSIBILITIES

• Directs managers and team responsible for identifying denial and disputed payment process breakdowns. Creates a culture in alignment with mission and values, fostering individual motivation, teamwork and high levels of performance and accountability utilizing a participative management style to ensure staff retention and engagement.
• Understands complexities involved in supporting denials activities spanning multiple states, regional health ministries, payer environments, and technologies to direct teams accordingly to achieve high performance and resolution on trends.
• Demonstrates strong management skills that emphasize team building and strong leadership with the ability to provide clear direction to the department, while also functioning as an individual contributor to achieve goals. Lead projects to improve denial claim performance, compliance and efficiency within the denials process and structures. Identifies action plans to improve the quality of services in a cost-efficient manner and facilitates plan implementation.
• Leads the team in identifying and correcting root cause of denied claims through process improvement.
• Oversees communication and follow-up processes related to denials and appeals to ensure such activities are submitted timely, tracked, trended, and reported to key stakeholders.
• Serves as a liaison to members of the medical staff and other regional colleagues, regarding denial management processes, systems, and requirements.
• Leads the redesign of denial management processes and systems to improve service, data integrity, and staff productivity/quality to achieve departmental goals and process outcomes.
• Provides education to departments regarding denials prevention and appeal success rates.
• Coordinates with Health Information Management and Case Management leadership on con-current denials. Review denial data appeals and under payment issues and/or revenue opportunities; report the revenue impact differential for issues identified, implemented, or corrected.
• Reports financial impact of denials; communicates findings to senior executives as needed.
• Performs other duties as assigned.

EDUCATION

• Bachelor's degree in business, healthcare or related field, or equivalent years of experience and education

EXPERIENCE

• Seven years' experience, with five years in leadership

Named 150 Top Places to Work in Healthcare 2023 - Becker's Healthcare

Named One of America's Greatest Workplaces for Diversity 2023 - Newsweek

Named One of America's Greatest Workplaces for Women 2023 - Newsweek

SSM Health is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through a robust and fully integrated health care delivery system. The organization's 40,000 team members and more than 12,800 providers are committed to providing exceptional health care services and revealing God's healing presence to everyone they serve.

With care delivery sites in Illinois, Missouri, Oklahoma and Wisconsin, SSM Health includes 23 hospitals, more than 300 physician offices and other outpatient and virtual care services, 13 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, a health insurance company and an accountable care organization. It is one of the largest employers in every community it serves.

To request additional information, confidentially submit your interest, or nominate a fellow colleague, please contact:

Angela Jones

Executive Talent Acquisition

Angela.Jones1@ssmhealth.com

SSM Health is committed to equal employment opportunity based on race, color, religion, national origin, gender, sexual orientation, gender identity, pregnancy, age, physical or mental disability, veteran status, and all other statuses protected by law.