• Lead multi-disciplinary research teams and provide HEOR expertise and strategic leadership at all stages of projects from planning to communication • Execute projects that exceed client expectations while remaining on-time, on-budget • Build relationships with clients that result in ongoing business opportunities • Promote a positive and energetic work environment through healthy and effective communication, a strong work ethic, and professional conduct

• Supervise the daily operations of the Provider Data Management team, including workload distribution, performance management, and staff development • Ensure provider demographic, credentialing, and contract data is accurately entered and maintained in all systems • Drive the performance of the team, by monitoring productivity, quality, and turnaround time standards • Provide coaching, mentoring, and performance feedback to team members • Manage attrition, shrinkage, and other critical metrics of the team. • Support projects involving system enhancements or process automation • Manage the end-to-end provider data entry process to ensure accurate and timely setup for claims payment, member assignment and directory display. • Investigate and resolve complex Provider Data Management issues. • Combine people management and provider data management experience, along with data analysis, and customer service experience from a healthcare operations background to drive success

• Develop and lead client relationships • Deliver Brand and Digital solutions • Engage with stakeholders • Manage budget • Generate strategic ideas • Lead project delivery • Ensure high quality project outputs • Write strategic creative briefs • Contribute to internal and external content

Role Description The Manager, Appeals and Denials is responsible for the day-to-day Appeals and Denials process by providing general oversight including leadership for the inpatient DRG/Coding Denials and Appeals process. Key responsibilities include: - Tracking, prioritizing, trending and writing appeal letters. - Identifying training and educational opportunities. - Delivering training and education to CDI Appeals Specialists, Coders and DRG reviewers. - Collaborating with the Appeals and Denials Team, CDI Team, Appeals Medical Director, Coding, DRG Team, and client healthcare team members. - Providing appeal letters that result in accurate, comprehensive documentation reflecting the true clinical picture of the patient. - Utilizing clinical expertise and clinical documentation improvement practices, current coding guidelines, and state and federal regulations for ethical coding. Qualifications - Registered nurse or Coding degree or certification, or Degree in Healthcare (Management, Healthcare Administration, Health Information Management) or other related field(s) required. - Minimum of 5 years appeals/denials or coding experience in the inpatient coding arena. - Minimum of 5 years of Management experience. - CCDS and/or CDIP certification or RHIA, RHIT certification(s) preferred. Requirements - Ensures compliance with external agencies as well as state and federal regulations for ethical coding. - Identifies and implements improvement measures that will enhance coding quality and client satisfaction. - Demonstrates appropriate knowledge and judgment regarding denials received from clients. - Supports education of the remote and onsite coding staff and appeal writers. - Identifies and documents patterns, trends and variations in coding data and collaborates with other departments to effect resolution. - Monitors the initiation, revision, and implementation of external regulations, statutes, and standards. - Assists with chart audit and analyzes denial letters, making recommendations for education, counseling or termination of staff as appropriate. - Reviews provisions for staff development, training and orientation prescribed by customers and any internal departmental standards. - Reviews denials received by client base, determines if denials are clinical or coding related, and develops and delivers training based on trends identified. - Assists with maintaining the integrity of data entry into Appeals and Denials tracking software. - Ensures adequate staffing for workload and assists teams when workload supersedes what the team can complete. - Reviews No Appeal letters to determine if appropriate, or if it can be appealed and provides Appeal Writer with feedback. - Assists Director Denials and Appeals Team with projects or tasks as assigned. - Performs miscellaneous job-related duties as assigned. Company Description