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Denials Manager Jobs in Texas (NOW HIRING)

MicroGenDX

Denials & Follow Up Specialist

Lubbock, TX

$18 - $20/hr

Works follow up report daily, maintaining established goal(s), and notifies manager of issues preventing achievement of such goal(s). Follows up on daily correspondence (denials, underpayments) to ...

MicroGenDX

Denials & Follow Up Specialist

Lubbock, TX · On-site

$18 - $20/hr

Works follow up report daily, maintaining established goal(s), and notifies manager of issues preventing achievement of such goal(s). Follows up on daily correspondence (denials, underpayments) to ...

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Denials Manager information

What is the difference between Denials Manager vs Claims Supervisor?

AspectDenials ManagerClaims Supervisor
CredentialsTypically requires healthcare administration, billing, or coding certificationsOften requires similar certifications, with additional supervisory or management training
Work EnvironmentManages denial appeals, reviews claim rejections, collaborates with billing and coding teamsOversees claims processing, supervises claims staff, ensures compliance with policies
Industry UsageCommon in healthcare, insurance, and hospital settingsCommon in healthcare organizations, insurance companies, and billing departments

While both roles focus on claims processing, the Denials Manager specializes in managing claim denials and appeals, whereas the Claims Supervisor oversees the entire claims process and staff. Both positions require healthcare billing knowledge and certification, but their primary responsibilities differ in scope and focus.

What are some common challenges faced by denials managers, and how can they effectively address them?

Denials Managers often encounter challenges such as identifying root causes of claim denials, staying updated with changing payer policies, and coordinating between billing, coding, and clinical teams. To address these challenges, Denials Managers typically implement robust tracking systems, conduct regular staff training, and foster open communication across departments. Proactively analyzing denial trends and collaborating on process improvements are key strategies to reduce future denials and enhance overall revenue cycle performance.

What is a denials manager?

A Denials Manager is a healthcare professional responsible for overseeing and managing the process of claim denials from insurance companies. Their primary role is to identify the causes of denied claims, implement strategies to reduce future denials, and ensure timely resolution and appeal of denied claims to maximize revenue for healthcare organizations. Denials Managers often collaborate with billing, coding, and clinical staff to ensure compliance with payer requirements and improve the overall reimbursement process. They play a crucial role in maintaining the financial health of medical practices or hospitals by minimizing lost revenue due to claim denials.

What are the key skills and qualifications needed to thrive as a denials manager?

To thrive as a Denials Manager, you need a deep understanding of medical billing, coding, insurance processes, and healthcare regulations, usually supported by a degree in healthcare administration or a related field. Familiarity with revenue cycle management systems, electronic health records (EHRs), and data analytics tools is essential, and certification like Certified Revenue Cycle Representative (CRCR) can be advantageous. Strong analytical thinking, problem-solving, and communication skills help in effectively leading teams and negotiating appeals with payers. These skills are critical for minimizing revenue loss, ensuring compliance, and optimizing reimbursement processes within healthcare organizations.
What are the most commonly searched types of Denials jobs in Texas? The most popular types of Denials jobs in Texas are:
What cities in Texas are hiring for Denials Manager jobs? Cities in Texas with the most Denials Manager job openings:
Denials Manager jobs near you

Chief Revenue Officer (CRO) - Administration - Full Time

OakBend Medical Center

Richmond, TX • On-site

$150 - $200/hr

Other

Re-posted 18 days ago

Job description

Responsibilities

The Chief Revenue Officer (CRO) is responsible for the strategic oversight and management of the entire revenue cycle process within the hospital, from billing to collections. This role demands an intimate knowledge of payor requirements and contracts, denials and appeals, and key business office KPIs such as clean claim rate, days in AR, Denial Rate, etc. The CRO will develop and execute strategies to enhance revenue cycle efficiency, minimize denials, and ensure optimal financial performance.

KEY RESPONSIBILITIES

Revenue Cycle Management:

  • Oversee all aspects of the hospital’s revenue cycle, including billing, coding, charge capture, and collections.
  • Develop and implement strategies to improve revenue cycle efficiency and effectiveness, ensuring the achievement of key financial goals.
  • Monitor and analyze revenue cycle performance metrics, including clean claim rate, days in AR, net collection rate, etc.

Payor Requirements & Compliance:

  • Maintain a thorough understanding of payor contracts, regulations, and reimbursement policies.
  • Ensure compliance with all federal, state, and local regulations related to billing, coding, and reimbursement.
  • Collaborate with payors to resolve issues, negotiate terms, and optimize reimbursement rates.

Denials Management:

  • Develop and implement a comprehensive denials management program to reduce denial rates and recover lost revenue.
  • Analyze denial trends to identify root causes and implement corrective actions.
  • Lead a team responsible for the timely review, correction, and resubmission of denied claims.

Appeals Process:

  • Oversee the appeals process, ensuring timely and effective resolution of denied claims.
  • Work closely with the clinical and coding teams to gather necessary documentation for successful appeals.
  • Track and report on the success rate of appeals, making improvements to the process as needed.

Team Leadership & Development:

  • Lead, mentor, and develop a team of revenue cycle professionals, including billing, collections, and denials management staff.
  • Promote a culture of collaboration and accountability, focusing on continuous improvement. Work closely with cross-functional partners to achieve shared goals.
  • Conduct regular performance reviews, offering continuous feedback, training, and development opportunities to enhance team capabilities

Strategic Planning & Reporting:

  • Work with executive leadership to develop and execute revenue cycle strategies that align with the organization's financial goals.
  • Prepare and present regular reports on revenue cycle performance, including trends in denials and appeals, to senior management.
  • Identify and implement best practices and emerging technologies to enhance revenue cycle efficiency and effectiveness.
Qualifications

MINIMUM EDUCATION:

Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field; Master’s degree preferred.

MINIMUM WORK EXPERIENCE:

Minimum of 7-10 years of experience in healthcare revenue cycle management, with at least 5 years in a leadership role.

REQUIRED LICENSES/CERTIFICATIONS:

None.

REQUIRED SKILLS, KNOWLEDGE, AND ABILITIES:

Knowledge and expertise in hospital managed‑care contracting, billing and collection for services provided. Intimate knowledge of payor requirements, including Medicare, Medicaid, and commercial insurance. Proven expertise in denials management and the appeals process. Excellent communication, negotiation, and leadership skills.

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