Associate Vice President of Denials Management and Revenue Integrity

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

Scheduled Weekly Hours:

40

Position Overview

Pay Range: $212,425-$290,145

ESSENTIAL FUNCTIONS

• Oversees the denial management process, ensuring that all denials are identified and addressed promptly and documented appropriately.
• Monitor and analyze denial trends, develop prevention and appeal strategies
• Interprets and reviews reports/conducts audits to ensure compliance with documentation and to identify opportunities for improvement; follows up on any areas/individuals identified as having room for improvement
• Engages with and works collaboratively with hospital Service Line leaders for the purposes of information gathering to enhance revenue cycle opportunities and reduce denials.
• Identifies and implement process improvements to enhance efficiency and reduce errors.
• Ensure compliance with all applicable laws, regulations, guidelines and standards.
• Collaborates with leadership to manage relationships with payers and other vendors, including billing, denials, collections services and other external stakeholders to optimize performance and cost.
• Stays current on industry trends and best practices in billing, collections and denial management and make recommendations for improvement.
• Implement strategic denial mitigation plan through management of day-to-day operations of department/service area; troubleshoot operational issues/barriers.
• Continuously develops and oversees Revenue Cycle Management Quality, Education, and Training programs throughout the entire Revenue Cycle. Ensures reeducation opportunities are identified and incorporated into the quality process.
• Oversees performance of vendor management team and ensures establishment of service level expectations and provides periodic updates to senior leadership.
• Monitors everchanging payor behavior and ensures continuous process improvement to reduce denials.
• Leads team that is responsible for identification of new charges, as it pertains to new and existing programs.
• Other duties as assigned.

MINIMUM REQUIREMENTS

• Education: Bachelor's degree in accounting, Finance or related field required. Master’s degree preferred.
• Experience: Ten years of progressive healthcare revenue cycle management experience required.
• Other Credentials:
• Knowledge and Skills: Understanding of the revenue cycle including billing, collections, denials and reimbursement processes. Strong leadership and management skills experience leading and developing high-performing teams. Ability to analyze financial data, identify trends, and develop strategies to improve financial performance. Knowledge of healthcare regulations and payer guidelines including Medicare, Medicaid, and commercial insurance regulations Excellent communication and interpersonal skills Strategic thinking and problem-solving skills. Ability to multi-task using organizational skills to manage multiple ongoing projects.
• Special Training: Knowledge of Financial systems, Proficient in Microsoft Office software. Proficient in Microsoft Suite, including Excel, Word and PowerPoint.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• Frequent physical demands include: Sitting , Standing , Walking , Keyboard use/repetitive motion , Talk or Hear
• Occasional physical demands include: Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities
• Continuous physical demands include:
• Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.
• Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing
• Anticipated Occupational Exposure Risks Include the following: Bloodborne Pathogens , Chemical , Airborne Communicable Disease , Extreme Temperatures , Radiation , Uneven Surfaces or Elevations , Extreme Noise Levels , Dust/Particulate Matter

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.