The Manager of Clinical Denials is responsible for the execution of operational and continuous improvement activities and achievement of expected performance in Clinical Denials Operations. Providing leadership and overseeing daily operations of the denials and underpayments functions for Piedmont Healthcare. Functions under the responsibility of Denials Management include working with both internal departments and external departments / agencies in order to ensure that all charges for hospital services are timely and accurately paid through appealing and resolving denied accounts / charges. This leader is responsible for managing the PHC Clinical Denials employees, relationships and performance management / reporting with 3rd Party Vendors who support PHC Clinical Denials Management and reports to the Executive Director of Care Management

The Manager of Clinical Denials is responsible for the execution of operational and continuous improvement activities and achievement of expected performance in Clinical Denials Operations. Providing leadership and overseeing daily operations of the denials and underpayments functions for Piedmont Healthcare. Functions under the responsibility of Denials Management include working with both internal departments and external departments / agencies in order to ensure that all charges for hospital services are timely and accurately paid through appealing and resolving denied accounts / charges. This leader is responsible for managing the PHC Clinical Denials employees, relationships and performance management / reporting with 3rd Party Vendors who support PHC Clinical Denials Management and reports to the Executive Director of Care Management

Education

• Bachelor’s Degree in Business, Healthcare Management or related field Required

Work Experience

• 5 years working knowledge of provider billing guidelines, payer reimbursement policies, and related industry based standards and healthcare managed care operations. Three (3) years experience directly managing a team Required


• Experience and success in appealing clinical denials and underpayment decisions Required

Licenses and Certifications

• N/A Required

Piedmont Healthcare