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Denials Manager Jobs in Wisconsin (NOW HIRING)

Froedtert

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI

$36.38 - $56.39/hr

Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third ...

FROEDTERT HEALTH

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI · On-site

$36.38 - $56.39/hr

Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third ...

Froedtert Health

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI · On-site

$36.38 - $56.39/hr

Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third ...

Bellin

Denials Coding Specialist

Green Bay, WI · On-site +1

The Denials and Coding Specialist - DRG Hospital Inpatient primarily manages payor DRG denials across Gundersen and Bellin regions. This role reviews inpatient medical records to assess coding ...

Champion Care

Case Manager

Milwaukee, WI

$20 - $24/hr

This role is critical in reducing denials, maintaining coverage, coordinating care, and supporting successful transitions for our residents. If you have experience as a SNF Case Manager, Insurance ...

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Champion Care

Case Manager

Milwaukee, WI · On-site

$20 - $24/hr

This role is critical in reducing denials, maintaining coverage, coordinating care, and supporting successful transitions for our residents. If you have experience as a SNF Case Manager, Insurance ...

Bielinski Management Inc

Association Manager

Waukesha, WI · On-site

$50K - $60K/yr

The Association Manager is responsible for the management of all Condominium Associations ... Coordinate timely processing, track approvals or denials, and communicate decisions clearly to ...

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Denials Manager information

What is a denial manager job description?

A denial manager oversees the process of reviewing and resolving insurance claim denials to ensure proper reimbursement. They analyze denial reasons, coordinate with healthcare providers and insurance companies, and implement strategies to reduce future denials, often using claims management software. Strong knowledge of billing, coding, and insurance policies is essential for this role.

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 the top 5 denials in medical billing?

For a Denials Manager, the top five medical billing denials typically include missing or incorrect patient information, coding errors such as CPT or ICD-10 mistakes, lack of pre-authorization or referral, services deemed not medically necessary, and duplicate claims. Addressing these common issues requires strong attention to detail, accurate documentation, and familiarity with billing software and coding guidelines.

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, and why are they important?

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 is the 3 month rule for jobs?

The 3 month rule for a Denials Manager typically refers to the standard review period for insurance claim denials, where claims are reassessed or appealed within three months of denial. This timeframe helps ensure timely resolution and compliance with payer policies, often requiring the manager to track and document denials and appeals efficiently.

What is the highest paying job in healthcare management?

In healthcare management, the highest paying roles are typically executive positions such as Chief Executive Officer (CEO) or Chief Operating Officer (COO), with salaries often exceeding $150,000 annually. These roles require extensive experience, leadership skills, and often advanced degrees like an MBA or healthcare administration certification.
What cities in Wisconsin are hiring for Denials Manager jobs? Cities in Wisconsin with the most Denials Manager job openings:
Denials Manager jobs near you
RN DENIALS MANAGEMENT HOURLY

RN DENIALS MANAGEMENT HOURLY

Froedtert

Milwaukee, WI

$36.38 - $56.39/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago

Job description

Discover. Achieve. Succeed. #BeHere

Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility.

This job is REMOTE.

FTE: 0.500000

Standard Hours: 20.00

Shift: Shift 1

Shift Details: 1/2 day Wednesday, Thursday and Friday Holidays: no Weekends: no

Job Summary:

Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.

EXPERIENCE DESCRIPTION:

A minimum of 5 years of acute care nursing experience is required. Prior utilization management, insurance background, and denial management experience is preferred.

EDUCATION DESCRIPTION:

Bachelor's degree is required. Professional knowledge of nursing theory and practice at a level normally acquired through completion of a minimum of four years education at an accredited School of Nursing in order to be eligible for licensure as a Registered Nurse is required.

TRAINING DESCRIPTION:

Previous experience with clinical validation denial review and appeal processes. Knowledge of ICD-10 Coding Guidelines.

SPECIAL SKILLS DESCRIPTION:

Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel. Analytical skills necessary to prepare statistical reports and develop solutions to problems. Technical writing ability for appeal letters and reports.

LICENSURE DESCRIPTION:

Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact).

Compensation, Benefits & Perks at Froedtert Health

Pay is expected to be between: (expressed as hourly) $36.38 - $56.39. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.

Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:

  • Paid time off
  • Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
  • Academic Partnership with the Medical College of Wisconsin
  • Referral bonuses
  • Retirement plan - 403b
  • Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
  • Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available


The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.

Employment Type: OTHER
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About Froedtert

Sourced by ZipRecruiter

Froedtert is a world-class healthcare organization based in Milwaukee, WI, United States. The company operates within the healthcare and wellness industry, providing a broad spectrum of medical services to the residents of southeastern Wisconsin and beyond. Froedtert was founded in 1980 and is an academic health network, which ripples an integrated affiliation with the Medical College of Wisconsin. The company prides itself on its cutting-edge treatments, sophisticated technology, and groundbreaking research. Froedtert’s mission is to advance health in the communities they serve, with a profound commitment towards patient care, education, research and community outreach.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Milwaukee, WI, US

Year founded

1980

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