This role has the potential of being a remote/hybrid position for the selected candidate. In ... Partner with Managed Care Contracting to ensure contract terms, reimbursement methodologies, and ...
This role has the potential of being a remote/hybrid position for the selected candidate. In ... Partner with Managed Care Contracting to ensure contract terms, reimbursement methodologies, and ...
Care Manager, LTSS (RN) Remote (Detroit MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
Preferred candidates will have previous case management, managed care, or inpatient hospital ... for approval or denial of services and informal ICT collaboration. • Uses motivational ...
Care Manager, LTSS (RN) Remote (Detroit MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
Preferred candidates will have previous case management, managed care, or inpatient hospital ... for approval or denial of services and informal ICT collaboration. • Uses motivational ...
Remote Denial Management information
What is remote denial management?
Remote denial management refers to the process of identifying, analyzing, and resolving insurance claim denials from a remote location, typically using digital tools and secure internet connections. Professionals in this role work to ensure that healthcare providers are reimbursed for their services by investigating the reasons for denials, appealing claims, and implementing strategies to reduce future denials. This job is crucial for maintaining healthy cash flow in medical practices and hospitals, and it often involves strong analytical, communication, and problem-solving skills.
What are some common challenges faced in remote denial management, and how can they be addressed?
Remote Denial Management professionals often encounter challenges such as limited access to physical records, communication delays with payers or healthcare providers, and navigating various billing systems. To address these, it's important to develop strong digital organizational skills, maintain clear and proactive communication with team members and external parties, and stay updated on payer policies and denial trends. Leveraging robust denial management software and collaborating with other revenue cycle teams can also help overcome these obstacles and improve claim resolution rates.
What are the key skills and qualifications needed to thrive in remote denial management, and why are they important?
To thrive as a Remote Denial Management Specialist, you need a strong understanding of medical billing, insurance claims processing, and healthcare regulations, often backed by experience in revenue cycle management or a related certification. Familiarity with denial management software, electronic health records (EHRs), and payer portals is essential for efficiently tracking and resolving claim denials. Attention to detail, excellent communication, and problem-solving abilities help specialists effectively appeal denials and collaborate with providers and payers. These competencies are crucial to ensure accurate reimbursement, reduce revenue loss, and maintain compliance in a remote healthcare environment.
What is the difference between Remote Denial Management vs Remote Claims Processing?
| Aspect | Remote Denial Management | Remote Claims Processing |
|---|---|---|
| Primary Focus | Handling claim denials, appeals, and resolution | Processing and submitting insurance claims |
| Skills & Certifications | Knowledge of insurance policies, denial codes, and appeals processes | Attention to detail, data entry, basic insurance knowledge |
| Work Environment | Healthcare providers, insurance companies, remote | Healthcare providers, insurance companies, remote |
| Industry Usage | Common in medical billing and revenue cycle management | Common in medical billing and claims submission |
Remote Denial Management focuses on resolving denied claims through appeals and follow-up, while Remote Claims Processing involves submitting and managing insurance claims. Both roles require insurance knowledge and are vital in healthcare revenue cycle management, but they differ in their primary responsibilities and workflow.
What are the most commonly searched types of Denial Management jobs in Michigan?
The most popular types of Denial Management jobs in Michigan are:
What are popular job titles related to Remote Denial Management jobs in Michigan?
For Remote Denial Management jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Denial Management jobs in Michigan look for?
The top searched job categories for Remote Denial Management jobs in Michigan are:
- Remote Insurance Verification
- Night Shift Payment Verification Specialist
- Work From Home R1 Rcm Medical Coding
- Remote Medical Billing Internship
- Remote Medical Billing Accounts Receivable
- Overnight Edi Billing Specialist
- Flexible Denial Management
- Volunteer Remote Medical Billing
- Remote Life Insurance Claims
- Work From Home Dental Billing
What cities in Michigan are hiring for Remote Denial Management jobs?
Cities in Michigan with the most Remote Denial Management job openings:
Full-time
Re-posted 16 days ago
Job description
The Associate Vice President (AVP), Reimbursement & Net Revenue Optimization provides strategic leadership and oversight of reimbursement and net revenue functions across Henry Ford Health. This role will lead two directors over Net Revenue Reporting and Cost Reporting who will be responsible for driving accuracy, transparency, and performance in net revenue results for all acute care hospitals, behavioral services, and employed providers. This role has the potential of being a remote/hybrid position for the selected candidate.
In addition to overseeing traditional reimbursement functions, this role will lead a systemwide transformation of Reimbursement and Net Revenue operations. The AVP will redesign team structures, improve upstream processes in collaboration with Revenue Cycle, Finance, Managed Care, System Analytics, and the Mosaic CIN. This leader plays a central role in telling the "story" of revenue performance while building durable processes that protect and optimize system revenue.
Principal Duties & Responsibilities
Net Revenue Leadership
Lead monthly net revenue modeling, forecasting, and variance analysis, ensuring accuracy and timely delivery of systemwide results.
Optimize net revenue reporting tools, methodologies, and analytic capabilities.
Direct the development of annual net revenue budgets in partnership with operational, financial, and contracting teams.
Coordinate with Value-Based Enterprise (VBE) leadership to ensure value-based revenues are accurately modeled and recorded.
Partner with Managed Care Contracting to ensure contract terms, reimbursement methodologies, and modeling tools align with net revenue assumptions.
Oversee balance sheet contractual reserve analyses and communicate financial drivers and trends to Finance leadership.
Direct third-party cost report filings, audit responses, and settlement calculations.
Reimbursement Transformation
Lead systemwide redesign of Reimbursement and Net Revenue operations, establishing integrated team structures that support accuracy, efficiency, and proactive revenue management.
Regulatory, Technology & Policy Strategy
Monitor regulatory and payer policy changes, assessing financial and operational impacts in coordination with Revenue Cycle, Managed Care, Government Affairs, and Policy.
Lead the development and execution of a comprehensive Reimbursement Playbook aligned with system priorities.
Evaluate and implement technologies and automation that improve efficiency, increase accuracy, and support scalable reimbursement operations.
Leadership & Organizational Culture
- Foster a collaborative, high-performing work environment focused on accountability, service excellence, and staff development.
- Provide education and consultation to internal stakeholders on reimbursement methodologies, regulatory changes, and revenue impacts.
- Manage multiple projects and priorities in a fast-paced environment while driving execution and measurable improvement.
Education & Experience Required
Bachelor's degree required; master's degree in business, health administration, finance, or related field preferred.
Certified Public Accountant (CPA) preferred.
Minimum 7 years of leadership experience in a healthcare organization, preferably within a large integrated health system.
Minimum 10 years of experience in reimbursement, net revenue modeling, or revenue integrity.
Extensive knowledge of reimbursement methodologies, payer requirements, and regulatory frameworks.
Demonstrated experience with net revenue modeling, cost reporting tools, and reimbursement technologies.
Strong understanding of revenue cycle operations, denial prevention strategies, and financial impacts to net revenue.
Excellent analytical, communication, and interpersonal skills; ability to effectively present complex financial concepts to leadership.
Proven ability to lead teams, develop talent, and manage multiple high-impact initiatives.
Additional Information
- Organization: Corporate Services
- Department: Revenue Cycle Administration
- Shift: Day Job
- Union Code: Not Applicable