Manager, Denials and Managed Care Contracting

Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties.

To learn more about Baptist Health, visit us at https://www.baptistfirst.org.

Highlights

The Manager, Denials and Managed Care Contracting will play a key role in protecting revenue, improving payer performance and KPIs and strengthening financial outcomes. In this role you will connect managed care contracting initiatives with denial prevention and resolution strategies to reduce financial impact and improve and accelerate cash flow. The Manager will monitor denial trends, payer performance, KPIs and root causes, translating these into favorable contract language, to improve performance. Collaboration and partnerships will be key within the revenue cycle and payers to strengthen payer relationships and improve reimbursement. Coaching and developing team members to create a robust denials program will be important to ensure the organization is performing at the highest level to improve processes and appeal outcomes.

Summary: The Manager, Managed Care shall be responsible for overseeing and direct operations of the Managed Care Contracting, Denials & Underpayments, and Denials Management teams. This individual is essential to develop and implement strategies to optimize managed care contracts, resolve payer denials and underpayments, and ensure compliance with regulatory and contractual obligations. The Manager will direct efforts by engaging payer leadership to resolve denials and underpayments and implement systemic improvements. This will include knowledge and experience in charge structure, hospital billing practices, and an understanding of clinical and technical denials. This position will be responsible for financial analysis of reimbursement, denial trends and contract performance, ensuring timely reporting. Additionally, the Manager will drive continuous improvement initiatives to enhance operational efficiency and financial performance. This position may have additional duties assigned that are within scope of the role.

Education/Experience

Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field required; Master's degree preferred. Minimum 10 years’ progressive experience in healthcare financial field. At least 5 years’ supervisory or management experience with proven leadership in team development.

Licensure/Certification

None

Knowledge, Skills, Abilities

• In-depth knowledge of managed care contracting principles and negotiation strategies.
• Understanding of healthcare billing, denial management, and appeals processes.
• Excellent knowledge of MS Office and familiarity with relevant computer software.
• Strong team leadership skills, strong organization, interpersonal, and customer relations skills.
• Must be able to meet strict deadlines.
• Strong analytical and problem-solving ability, and excellent organizational skills.
• Must be able to complete multiple tasks simultaneously.
• Ability to remain calm in difficult situations.
• Strong written and oral communication skills, proficient computer skills, proven track record of successful performance.
• Ability to understand complex multifactor situations and bring appropriate solutions.
• Ability to work both independently and in a team environment.

Primary Location:

Corporate

Job

Manager, Denials and Managed Care Contracting

Manager, Managed Care

Job Type

Regular-Full time

Shift

First Shift (United States of America)