Providence Health & Services Director, RCS Enterprise Clinical Denials (Registered Nurse) in Oregon
Providence St. Joseph Health is calling a Director, RCS Enterprise Clinical Denials ( Registered Nurse). This role works 100% remotely so candidates for this role may reside in Alaska, Washington, Montana, Oregon, California or Texas.
Applicants that meet qualifications will receive a text with an additional question from our Modern Hire system.
We are seeking a Director, RCS Enterprise Clinical Denials (Registered Nurse) to be responsible for all aspects of Revenue Cycle clinical denials with direct operational accountability for all Revenue Cycle clinical denials across the enterprise. The Director is responsible for assisting in the development of a strategic plan to establish an clinical denials center of excellence (COE) and oversee COE operations and meet the goals of the clinical denials program, in partnership with the leaders of PSJH RCS Services. This position will have responsibility for participation in the leadership of RCS Senior Managers and COE RN Case Managers to ensure clinical denial activities are standardized across Providence St. Joseph Health, and that all policies, procedures, and strategies adhere to the guidance and vision of the centralized Revenue Cycle function. The Director will continuously audit workflows, assess risk and propose improvements with a focus on automation and analytical techniques to eliminate workflow variations and support real-time / data-driven discernment to produce consistent results.
Partners with the Executive Director, RCS Enterprise Denial Management and other system level leaders on Revenue Cycle process improvement, training, technology innovation, analytics, compliance, contracting and vendor management. The Director of the RCS Enterprise Clinical Denials will continually review the current state and work with the Executive Director RCS Enterprise Denial Management, the Associate Vice President of Denials and Underpayments and other PSJH Senior Revenue Cycle leaders to move the organization to leading practices. The Director RCS Enterprise Clinical Denials is responsible to ensure policies and procedures are current and enforced, business practices are compliant, and a high level of patient and customer satisfaction is maintained across the region. Promotes an environment shaped by health, healing, hope, diversity, and mutual respect. Is self-directed and requires minimal supervision.
In this position you will:
Develop, evaluate, monitor and communicate the long and short term strategic objective of the revenue cycle clincial denials function, ensuring consistency and alignment with the strategic objectives of the centralized revenue cycle organization, and PSJH. Responsible to achieve annual performance goals as established by the Chief Revenue Cycle Officer for PSJH.
Develop and execute a detailed plan to improve overall clinical denial performance in the revenue cycle and to continually collaborate with patient access, HIM, RN case managers, billing team and contracting leadership to improve registration accuracy, coding accuracy, reduce days in AR, increase cash collections, reduce bad debt, eliminate write-offs due to revenue process issues and improve customer and patient satisfaction.
Establish and maintain a best in class workflow for the timely follow-up, escalation and resolution of clinical denial related issues. Develop and maintain a dispute resolution notification and escalation process to engage the appropriate PSJH leaders, including Payor Contracting, Legal utilization management, coding and compliance, when pursuing clinical denials at an enterprise level. This includes creating and overseeing a clinical denial appeals submission and follow-up workflow and leading or participating in payor/Providence JOCs meant to escalate and address clinical denials at Ministry, Regional and Enterprise levels.
Establish and maintain meaningful partnerships with medical directors and nurses in the insurance companies, medical groups and other third-party payors to aid in the timely recovery of additional reimbursement for hospital based services in accordance with executed third-party payor contracts and/or other applicable governing regulations or contracts.
Lead a team of RN case managers that will provide continuous audits of all related workflows including but not limited to: risks and risk mitigation, provider and payor compliance, information technology systems (internal and add-ons) and standard operating procedures with an eye towards optimization, automation and timely information exchange between key stake holders to drive performance.
Evaluate the clincal denial COE's processes and base information technology infrastructure to streamline operations and perform as a strategic business partner to influence change and recommend new processes up/down stream of the Revenue Cycle process to reduce waste in line with Lean Six Sigma methodology and increase revenue.
Provide shared operational leadership to all ministries in the organization related to clinical denials. Provide shared leadership and supervision to the areas of oversight.
Partner with other Revenue Cycle leadership to lead the development and implementation of policies, procedures and workflows which impact net revenue cash flow or performance efficiency across the Revenue Cycle function that align with the strategic direction and standardization for all of PSJH.
Partner with system wide Revenue Cycle leadership to develop process improvement opportunities, training, technology innovation, analytics, compliance and vendor management to meet underpayment improvement and maintain industry best practice needs.
Collaborate with other PSJH ministries and provides leadership in communicating consistent information and data regarding clinical denial performance.
Collaborate with PSJH Contracting to understand contract specifics and provide PSJH Contracting with data to support negotiations with payers and development of contracting strategies. Develop relationships and collaborate with leaders at the payer level to improve appeal turnaround and dispute resolution.
Manage and oversee the development of technology solutions to improve efficiencies and reduce the delays in workflow processes.
Develop and insure that the activities of the clinical denial processes are performed in accordance with state and federal regulations, mandated collection practices, all regulatory agencies including JCAHO, and are HIPAA compliant.
Develop and monitor an annual operational budget as well as any capital budget requests, and complete all fiduciary responsibilities.
Actively collaborates with the financial leaders across PSJH to ensure the goals and strategic initiatives are aligned and whenever feasible, operational procedures are standardized.
Required qualifications for this position include:
Bachelor's Degree in Nursing; Registered Nurse or equivalent educ/experience
10 years related experience in healthcare, revenue cycle or finance; 10 years leadership experience. Proven ability to work collaboratively in group settings with various stakeholders, including executive leadership and clinicians.
Organizing, planning, facilitating, and coordinating skills
Excellent oral/written communication skills
Demonstrated success in leading large, complex change initiatives
Excellent leadership ability to include motivating & developing others
Excellent interpersonal skills and ability to work with all levels of management and staff
Preferred qualifications for this position include:
MBA or MHA
10 years leadership experience, preferably with responsibilities that span multiple entities
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Non-Clinical Lead/Supervisor/Manager
Other Location(s): Montana, California, Washington, Oregon, Texas, Alaska
Req ID: 301820