Director Prebill Denial

  • HCA
  • Nashville, TN, USA
  • Jan 11, 2018

Job Description

Job Code: 26512-143445


No Weekends

The Prebill Denial Director will be responsible for daily operations of all functions and oversight of prebill denial team members and serve as the Service Center liaisons for denial projects, questions and meetings with, Division Denials Director, Facility Leadership and other team members within the organization. This position will organize the structure of the program and hire all necessary staff to complete the program's objectives as well as monitor and track status of all departmental responsibilities. Establishing and maintaining relationships with all customers, including SSC executive staff, prebill denial unit staff, Appeals staff, hospital executive management team members, hospital and SSC department directors, payers, and others is a key responsibility. Additional responsibilities may include conducting onsite visits to facilities and payers, assessing workflows and operations.

The Prebill Denials Director responsibilities also include mandatory root cause analysis of prebill denials and collaborate with Appeals director to understand root cause and trends to decrease new denials and final write off denials by identifying operational opportunities that will decrease denials overall, such as contract language, patient access process changes, case management collaboration, appeal opportunities, etc. In addition, the director will be responsible for monitoring, trending, and communicating with SSC Leadership, Division Denials Director, and Facility Leadership regarding denial trends identified via New Denials and Final Write-Off Denials analysis. Must demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner.

Duties (included but not limited to):
Oversight areas:
  • Prebill denials, new denials and Final write off denials root cause and trending
  • Work with HCA Division Denials Directors as a SSC Liaison to the Denials Management Action Team (DMAT) Project
  • Monitors and reports on execution of SSC DMAT action plans
  • Monitor, trend, and communicate denial reduction opportunities identified through root cause analysis to SSC Leadership, Division Leadership, and Facility Leadership
  • Assist with the implementation of the SSC action plans to reduce denials
  • Verification of authorization of services after discharge and before bill is released to the payer
  • Validation of authorization in payor system prior to claim submission as needed
  • Re-certification for additional days after discharge but before bill is released to the payer
  • eRequest queues as determined during program implementation

Analyze insurance denial trends identified using New Denials and Final Write Off denials reports and work with SSC Departments, Division and Facility Leadership to implement process improvements to resolve and reduce denials
• Daily oversight of daily PDU Tool import volume, analysis, and resolution of denials prebill
• Understand and communicate contract specific issues related to prebill denials for all payors, except Medicare to Strategic Pricing Analytics
• Monitor, trend, and communicate significant shifts in market or operating conditions to SSC Leadership, Division and Facility Leadership
• Manage daily activities related to Prebill denials unit, ensuring processes are performed efficiently and effectively
• Establish and maintain relationships with all customers, including: SSC executive management team, hospital executive management, SSC and hospital department directors, Case Management staff, payers and others as needed or required
• Review each staff member's productivity and QA on a monthly basis and perform annual evaluations
• Hire all necessary staff to perform departmental operations
• Establish productivity and QA standards including controls and review mechanisms for SSC policies and procedures
• Monitor and track status of department responsibilities
• Counsel staff with QA and productivity issues
Maintain strictest confidentiality to ensure that privileged and/or proprietary information is adequately safeguarded against disclosure
• Develop specific objectives, budgets, and performance standards for each area of responsibility
• Identify and implement process improvements to lower costs and improve service to facility customers
• Assume a lead role for innovation, knowledge sharing and leading practices identification within the SSC and among peer group
• Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
• Other duties as assigned


Bachelor's Degree in Business or related field required. If a desired applicant does not have a Bachelor's Degree the requirement can be waived IF they are currently in a Bachelor Degree program.

Minimum 5 years healthcare management experience with three of these years in the related area for the position. Relevant education may substitute experience requirement with SSC Executive approval

Technical Expertise - Some understanding of healthcare including knowledge of healthcare terms and accounts receivable processes and basic payer rules, which affect reimbursement and/or compliance requirements. Understands basic payer rules which affect reimbursement and/or compliance requirements, Understands case management operations and workflow as it relates to the communication and authorization process with all Payors (except Medicare).
Strategic Analysis - Analytical Review skills and ability to make decisions based on analysis
Leadership - guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
Tactical execution - oversees the development, deployment and direction of complex programs and processes
Financial management - applies tools and processes to successfully manage to budget
Project Management - assesses work activities and allocates resources appropriately
Organization - proactively prioritizes needs and effectively manages resources
Communication - communicates clearly and concisely, verbally, and in writing. This includes utilizing proper punctuation, correct spelling, and the ability to transcribe accurately. The ability to communicate with staff, Parallon Management, Division, and Group Executives
Customer orientation - establishes and maintains long-term customer relationships, building trust, and respect by consistently meeting and exceeding expectations
Interpersonal skills - able to work effectively with other employees, patients, and external parties
PC skills - demonstrates proficiency in Microsoft Office applications and others as required
Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
Operational Knowledge - Familiarity with daily operations of Revenue Cycle including understanding of front/back office operations, patient flow, and staff work assignments and integration of major components of the Revenue Cycle, including patient registration, coding, charging, managed care, cash management, and billing.
Basic Skills - demonstrates ability to organize, perform, and track multiple tasks accurately in short timeframes, have ability to work quickly and accurately in a fast-paced environment while managing multiple demands, ability to work both independently and collaboratively as a team player, adaptability, analytical and problem solving ability and attention to detail and able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly. Spell correctly and transcribe accurately

Last Edited: 01/10/2018