Director of Fiscal Affairs (Director of Denial Management) - Nyc Health Hospitals : Job Details

Elmhurst Hospital Center (EHC) is the major tertiary care provider in the borough of Queens. The hospital is comprised of 545 beds and is a Level I Trauma Center, an Emergency Heart Care Station and a 911 Receiving Hospital. It is the premiere health care organization for key areas such as Surgery, Cardiology, Women's Health, Pediatrics, Rehabilitation Medicine, Renal and Mental Health Services.At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.Work Shifts9:00 A.M - 5:00 P.MJob DescriptionThe Director of Fiscal Affairs (Director of Denial Management) manages and oversees Elmhurst's Denial Management operations. This position reports to the Chief Financial Officer.Duties & Responsibilities

• Managing Medical Necessity Denials, Authorization Denials, Timely Filing Denials, etc. investigate the reasons for the denials, including reviewing charts, creating detailed reports on denial trends, and providing financial analyses. Recommend and offer suggestions for reducing denials.
• Ensure open communication with clinical teams, financial teams, and insurance companies to manage and minimize denials effectively.
• Detects and reports system-related issues through monitoring the EPIC AP. dashboard, interdisciplinary team meetings, and data analysis, as well as identifying real-time issues through the daily work oi patient Accounts Teams.
• Acts as a liaison between Patient Accounts and other departments (e.g., HIM, Revenue integrity, OPD Finance, Admitting, Ambulatory Care, Managed Care, and Clinical Services) to identify and resolve issues contributing to claim errors and denials.
• Participates in corporate revenue cycle service (RCS) facility work groups (e.g., Timely Filing Task Force, Billing council, RCS-PAD) to enhance revenue cycle performance.
• Ensure compliance with corporate, hospital, and departmental policies and procedures.
• Represent the hospital in Corporate Finance/RCS meetings when delegated by the Chief Financial Officer.
• Participate in seminars and workshops to stay up-to-date with healthcare industry regulations impacting billing, collections, and denials management (e.g., seminars sponsored by CMS,-GNVHA, HANYS, etc.
• Notifies all members of the health care team, i.e., physicians, nurses, case managers, and social workers, of the denial and initiates a concurrent appeal process, i.e., expedited appeal and/o-r peer-to-peer.
• Oversee the development and utilization of advanced analytical tools and methodologies to identify denial trends and opportunities for improvement.
• Contacts managed care companies to convey the clinical justification for admission and continued stay in collaboration with utilization Management and physician advisor.
• Coordinates and sets up concurrent expedited appeal process as requested. ' Work with external outsourced vendors, such as MRI, to ensure high-quality case reviews and track overturn rates and payments received.
• identify and implement processes and technologies to improve timeliness and reduce unbilled / denied claims.

Minimum Qualifications1. Master's degree from an accredited college or university in Accounting, Finance, Business Administration or a related discipline with an emphasis on accounting and financial systems; and four (4) years of responsible-level experience in fiscal management or administration with an emphasis on financial systems, management information and controls, three (3) years of which must have been in responsible administrative or managerial capacity; or2. Bachelor's degree from an accredited college or university in disciplines, as listed in 1 above; and five (5) years of experience, as described in 1 above, three (3) years of which must have been in a responsible administrative or managerial capacity.Department PreferencesEDUCATION LEVEL:

• A Master's Degree with a specialization in Hospital Administration, Health Care Administration, Administrative Medicine, or in Public Health when conferred for a program in Hospital Administration from an accredited college or university and:
• Six years of high-level responsible experience in Hospital Administration, Business Administration, Public Administration, or an equivalent field, or as an Assistant to a Hospital Administrator in a position of direct responsibility for operations of a major part or all of a hospital, including substantial exposure in meeting community health needs or:
• An equivalent combination of training, education and experience in related fields and educational disciplines; and
• Thorough knowledge of fundamentals of hospital organization, administration, standards, regulations and laws applicable to hospital operations, knowledge of business and human resources administration principles, management functions, management processes and functions of hospital departments, and ability to direct and supervise personnel.

KNOWLEDGEABLE IN:

• Fundamentals & principles of Hospital Revenue Cycle.
• City State & Federal policies & requirements applicable to hospital billing, follow-up & appeals.
• investigation and resolution of billing inquiries (Customer level; Regulatory-Audit level).

PREFERRED SKILLS:

• Strong leadership & organizational skills.
• Experienced with policies and programs utilized in operation of a health care facility, ability to assimilate & analyze data, to recommend action based on analytical findings and to assist in the solution of complex problems in health care administration and management.
• Strong communication skills written &oral
• Strong time management & people management skills.
• Ability to work well under pressure & to prioritize & reprioritize work/team assignments.
• Flexible & reliable.
• Computer savvy.

EQUIPMENT/MAGHINES OPERATED:

• PC, Laptop, scanners, all-in-one ( printer/scanner/fax)

COMPUTER PROGRAMS/ SOFTWARE OPERATED:

• EPIC
• Government, commercial & other payer websites & portals.
• Microsoft Office: Excel, Word, PowerPoint, Access

YEARS OF EXPERIENGE:

• An equivalent combination of training, education background and experience in related fields and educational disciplines.

If you wish to apply for this position, please apply online at employment.nychhc.org.NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs