Description

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott & White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.

• We never settle by constantly striving for better.

• We are in it together by supporting one another and those we serve.

• We make an impact by taking initiative and delivering exceptional experience.

Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• Immediate eligibility for health and welfare benefits

• 401(k) savings plan with dollar-for-dollar match up to 5%

• Tuition Reimbursement

• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Job Summary Manages the staff and day-to-day operations of assigned departments within the Denial Resource Center (DRC) to ensure timely and effective denial resolution through the intake and setup of new denials, submission of appeals to payers and other entities and effective follow-up collections. Works closely and collaboratively with other departments on account research and resolution. Maintains a very high level of situational awareness of department operations, identifying and resolving challenges while providing high-touch leadership and support to our team members.

Essential Functions of the Role

• Cultivate a supportive, respectful and engaging work environment where team members feel valued, heard and empowered to perform at the top of their capabilities. Demonstrate empathetic leadership, coaching and support of direct reports.

• Effectively manage the productivity and overall success of teams, ensuring that all appeal and collection functions are timely and accurate through hands-on management and frequent analysis of trends in departmental volumes, backlogs, aging and productivity data using high level analytic skills.

• Maintain effective professional relationships with other Revenue Cycle departments and external organizations including the Centralized Business Office, Managed Care, Payers, External Vendors and Quality and Provider Review Organizations.

• Work very closely with other Managers and Supervisors within the DRC to collaborate on process improvement with the goal of achieving high-quality appeals that are timely and followed up on promptly to prevent any avoidable loss of revenue.

• Review and analyze activity at the account level to determine appropriate actions and resolve questions and challenges with work queues within the DRC as well as between the DRC and other departments.

• Identify workflow and training gaps and identify opportunities for professional development and process improvement. Advocate for resources needed, including conducting analysis and creating business cases as indicated.

• Conduct frequent meetings with direct reports. Participate in Huddles and other Team Meetings, providing presentations as needed.

• Accomplish both small and large projects within allocated timelines, meeting goals with minimal oversight

• Apply in-depth knowledge of Revenue Cycle operations and managed care contracting to solve challenges and guide teams in the development of successful workflows and outcomes.

Key Success Factors

• Associate's degree or 6+ years of experience required.

• CRCR (Certified Revenue Cycle Representative) certification preferred.

• 4+ years of experience in medical billing, revenue cycle operations, or denial and appeals management.

• Experience within a hospital or health system revenue cycle environment required.

• Working knowledge of payer guidelines, reimbursement methodologies, and denial/appeal processes.

• Familiarity with clinical workflows and strong relationship building skills with clinical teams is a strong plus.

• Proficiency in Microsoft Office applications and revenue cycle systems; Epic experience required.

• Strong analytical skills with the ability to interpret remits, payer responses, and supporting documentation.

• Effective written and verbal communication skills, with the ability to draft clear and professional correspondence, business plans and presentations.

• Demonstrated ability to work independently, manage priorities, and consistently meet deadlines in a high-volume environment.

Belonging Statement We believe that all people should feel welcomed, valued and supported.

QUALIFICATIONS

• EDUCATION - Associates Degree or 6+ Years of Experience

• EXPERIENCE - 4 Years of Experience