Director of Appeals in Houston, TX at Parallon

Date Posted: 3/6/2018

Job Snapshot

  • Employee Type:
  • Location:
    8101 West Sam Houston Parkway South
    Houston, TX
  • Job Type:
  • Experience:
    At least 5 year(s)
  • Date Posted:

Job Description

Job Summary – The Appeals Director is responsible for daily operations of all functions and oversight of all activities related to monitoring and appealing denials received from Third Party Payers. The Director will serve as a key liaison between the SSC CFO, Division CFOs, Case Management, PDU Director, Appeals Managers, Facility CFOs, PADs, and other team members within the organization regarding denials and appeals.

Supervisor – SSC Back Office COO

Supervises – Appeals Department Staff Duties (included but not limited to):
  • Oversee the activities and management related to denial inventory, ensuring processes are performed efficiently, effectively and accurately within all established operational and SOX guidelines.
  • Establish controls and review mechanisms for SSC policies and procedures.
  • Ensure timely submission of appeals and liquidation of denials inventory.
  • Provide support and guidance related to the Denials Management Action Teams (DMAT)
  • Monitor, trend and communicate with SSC Leadership, Case Management, Denials Managers, and Facility Leadership regarding denial trends, new denials and final write off denials identified via EDW, Visual Insight Dashboard, Vista, and other denials tools reports.
  • Demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner.
  • Understand and communicate contract specific issues related to the resolution of disputed payments, discount and allowance calculations for a variety of payers such as Medicare, Medicaid, HMOs, PPOs, IPAs, employers, etc.
  • Oversee management of personnel, providing recommendations for hiring,
    promotion, salary adjustment and personnel action where appropriate.
  • Follow escalation protocols to include Attorney, Corporate Dispute Resolution, Strategic Pricing and Analytics, and Corporate Payment Compliance.
  • Participate in Joint Operating Committees (JOC) with payers, ensuring partnership in inventory resolution.
  • Oversee all reconciliation activities for inventory.
  • Proactively ensure training of all employees, including identification and communication of any operational gaps identified in day to day activities.
  • Monitor trends and communicate significant shifts in market or operating conditions to SSC and facility leadership.
  • Identify and implement process improvement initiatives that reduce cost and improve performance.
  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
  • Other duties as assigned.

Job Requirements

  • Technical Expertise – Some understanding of healthcare including knowledge of healthcare terms and accounts receivable processes
  • Strategic Analysis - Analytical review skills and ability to make decisions based on analysis
  • Leadership - Guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
  • Tactical Execution - Oversees the development, deployment and direction of complex programs and processes
  • Financial Management - Applies tools and processes to successfully manage to budget
  • Project Management - Assesses work activities and allocates resources appropriately
  • Organization - Proactively prioritizes needs and effectively manages resources
  • Communication - Communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately. The ability to communicate with staff, Parallon Management, Division and Group Executives
  • Customer Orientation - Establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
  • Interpersonal skills - able to work effectively with other employees, patients and external parties
  • PC Skills - Demonstrates proficiency in Microsoft Office applications and others as required
  • Policies & Procedures - Demonstrates knowledge and understanding of organizational policies, procedures and systems
  • Basic Skills – Demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes. Demonstrates ability to work both independently and collaboratively as a team player.
    Bachelor’s Degree in Business or related field required.
    Minimum 5 years healthcare management experience with three of these years in the related area for the position. Relevant education may substitute experience requirement with SSC Executive approval.