BJC HealthCare logo
BJC HealthCare

BJC HealthCare is one of the largest healthcare organizations in the U.S. focused on delivering "the world's best medicine," made better by its 30,000+ clinical

Program Integrity Appeals Manager

Location

United States

Posted

31 days ago

Salary

0

Seniority

Lead

No structured requirement data.

Job Description

Program Integrity Appeals Manager

BJC HealthCare

Role Description Join our team in a dynamic leadership role focused on managing complex healthcare appeals and driving revenue recovery across the organization. Enjoy the flexibility of a fully remote work environment along with a flexible schedule, allowing you to balance professional success with personal priorities while making a meaningful difference. Responsibilities - Manages individual(s) including but not limited to: hires, trains, assigns work, manages & evaluates performance, conducts professional development plans. - Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership. - Designs, develops and implements BJC‘s integrity appeals program. - Administers and directs the appeals process by communicating directly with program integrity audit contractors. - Designs, develops and manages medical necessity audits, including those related to observation and one-day stay billing. - Develops processes and policies for effectively tracking and managing audit denials and evaluates internal and external systems for enhancing efficiencies. Qualifications - High School Diploma or GED - 5-10 years of experience - 2-5 years of supervisory experience Preferred Qualifications - Bachelor's Degree in Business, Healthcare Administration, Nursing, or related field - 10+ years of experience Benefits - Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date - Disability insurance paid for by BJC - Annual 4% BJC Automatic Retirement Contribution - 401(k) plan with BJC match - Tuition Assistance available on first day - BJC Institute for Learning and Development - Health Care and Dependent Care Flexible Spending Accounts - Paid Time Off benefit combines vacation, sick days, holidays and personal time - Adoption assistance

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