Denial and Development Lead (Finance)

Nemours is seeking a Denial and Development Lead in Jacksonville, FL.

The Denial and Development Lead will serve as a lead for the reimbursement teams. This position has two primary functions. The first is to assist in the initial onboarding and training of new hires and associates who need refresher training. The position is responsible for making and implementing a training plan for new hires, showing them the ins and outs of reimbursement and how reimbursement is followed up on in the CBO. In addition, this position would be asked to create and teach classes to the team. The second function, to be done if no training needs are noted as needed by supervisor/manager, is to serve as a denial lead reporting to the designated leader, this person would use their knowledge of the revenue cycle to analyze, report and work reimbursement issues with various internal departments and external entities at all levels to create reliable methods for future resolution, i.e. pulling and analyzing reports, working AR, and reporting trends.

Essential Functions

Make and implement training plan for new hires, as well as training plans for new processes, or established team members who may need additional training, including training classes.

Proficient knowledge of how people learn and how to tailor training to different learning styles

Manage all onboarding requirements for new hires, such as a desk (if in office) and tickets for all necessary system, phone and website access.

Acts as resource for questions and training the reimbursement teams reporting up to the designated supervisor or manger to which this position is assigned. Fill in for reimbursement team or supervisors who may be out on leave.

Assist supervisor/manager with audits of reimbursement team accuracy in order to provide additional training or clarity on processes.

Understand and apply principles of reimbursement to all aspects of the revenue cycle including but not limited to billing, coding, reimbursement, recovery, and patient responsibility. Including a thorough knowledge of current contracts, including reading, understanding, and applying contractual language to a claim.

Analyze third party denials and prepare relevant reports regarding trends and denials. This position will obtain, manipulate and analyze data from a variety of sources, including but not limited to: physician billing systems, hospital billing systems, contract management systems and claims systems. Then in turn have the ability to pursue additional payment from payors on underpayment discrepancies through various means of communication including verbal and written platforms i.e email, appeals, etc.

Apply problem solving skills to resolve discrepancies while maintaining a professional demeanor that promotes patient, staff and customer satisfaction, and reflects the Mission, Vision, and Values of Nemours when working with either insurers or the insured.

Strong leadership skills that inspire the cooperation and confidence of peers and superiors. Proven history of excellent performance in achieving set goals. Demonstrated ability to identify, analyze and solve problems. Must be able to demonstrate an understanding of project management tools, methodologies, and techniques

Attend monthly payor meetings and phone conferences . As well as any additional miscellaneous duties, and responsibilities, as may be assigned from time to time by employee's manager

Requirements:

High School Diploma

3-5 yrs experience

About Us

Nemours Children's Health is an internationally recognized children's health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children's hospitals - Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida. Our pediatric network includes 80 primary-urgent-and specialty care practices and more than 40 hospitalists serving 19 affiliated hospitals. We generate annual revenues of more than $1.7 billion derived from patient services, contributions from the Alfred I. DuPont Trust, as well as other income.

As one of the nation's premier pediatric health systems, we're on a journey to discover better ways of approaching children's health. Putting as much focus on prevention as cures and working hand in hand with the community to make every child's world a place to thrive. It's a journey that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention, leading to the healthiest generations of children ever.

Inclusion and belonging guide our growth and strategy. We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build an inclusive and supportive environment. All of our associates are expected to ensure that these philosophies are embedded in their day-to-day work with colleagues, patients and families.

To learn more about Nemours Children's and how we go well beyond medicine, visit us at www.nemours.org .