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Executive Medical Director Denials Management

Job Description


Description

Executive Medical Director

AdventHealth Corporate
Location Address: 2600 Lucien Way, Maitland, FL 32751
 

Top Reasons to Work at AdventHealth Corporate

  • Great benefits
  • Immediate Health Insurance Coverage
  • Career growth and advancement potential 
Work Hours/Shift:
  • Full-Time, Monday – Friday

You Will Be Responsible For:

  • Providing physician review of post-remittance denials, writing and submitting clinical denial appeals when required
  • Performing peer-to-peer discussions with payer medical directors and/or discussing cases with payer representatives to facilitate claim resolution and build payer relationships
  • Utilizing clinical knowledge and experience, information science, data analysis, and interpersonal skills to support and represent the optimal denials recovery and prevention processes identified with all medical, clinical and ancillary departments
  • Researches and responds to denials in a timely fashion and identifies trends through data analysis
  • Responds to identified trends by recommending changes in practice and/or provider documentation to promote denial prevention initiatives
  • Serves as a subject matter expert, providing clinical expertise and business direction in support of best practice, world class denial management and prevention strategies
  • Adheres to AdventHealth Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

Qualifications

What You Will Need:
  • Graduate from medical school and residency program
  • Five years recent clinical practice experience
  • Seven years of leadership experience          
  • Current, valid state license as a physician
  • Board certified and eligible for membership on the Hospital medical staff
 
 
Job Summary:
 

The Denials Management Executive Medical Director is an integral member of the centralized denial management team who provides physician review of post remittance clinical denials and supports optimal denials recovery and prevention processes through their clinical knowledge and experience.  The Denials Management Executive Medical Director educates, advises, and informs members of the Denial Management, Revenue Cycle, Managed Care, and applicable Medical Staff leaders of specific issues and prevention initiatives related to clinical denial management.



This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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Job Description: Executive Medical Director Denials Management

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Description Executive Medical Director AdventHealth Corporate Location Address:  2600 Lucien Way, Maitland, FL 32751   Top Reasons to Work at AdventH

Description

Executive Medical Director

AdventHealth Corporate
Location Address: 2600 Lucien Way, Maitland, FL 32751
 

Top Reasons to Work at AdventHealth Corporate

  • Great benefits
  • Immediate Health Insurance Coverage
  • Career growth and advancement potential 
Work Hours/Shift:
  • Full-Time, Monday – Friday

You Will Be Responsible For:

  • Providing physician review of post-remittance denials, writing and submitting clinical denial appeals when required
  • Performing peer-to-peer discussions with payer medical directors and/or discussing cases with payer representatives to facilitate claim resolution and build payer relationships
  • Utilizing clinical knowledge and experience, information science, data analysis, and interpersonal skills to support and represent the optimal denials recovery and prevention processes identified with all medical, clinical and ancillary departments
  • Researches and responds to denials in a timely fashion and identifies trends through data analysis
  • Responds to identified trends by recommending changes in practice and/or provider documentation to promote denial prevention initiatives
  • Serves as a subject matter expert, providing clinical expertise and business direction in support of best practice, world class denial management and prevention strategies
  • Adheres to AdventHealth Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

Qualifications

What You Will Need:
  • Graduate from medical school and residency program
  • Five years recent clinical practice experience
  • Seven years of leadership experience          
  • Current, valid state license as a physician
  • Board certified and eligible for membership on the Hospital medical staff
 
 
Job Summary:
 

The Denials Management Executive Medical Director is an integral member of the centralized denial management team who provides physician review of post remittance clinical denials and supports optimal denials recovery and prevention processes through their clinical knowledge and experience.  The Denials Management Executive Medical Director educates, advises, and informs members of the Denial Management, Revenue Cycle, Managed Care, and applicable Medical Staff leaders of specific issues and prevention initiatives related to clinical denial management.



This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
....  read more -->>

About Us

About Adventist Health System
Adventist Health System is an organization rich in the tradition of providing quality health care in a mission-minded environment. We employ more than 80,000 individuals in our hospitals, nursing homes, home health agencies, headquarters and other affiliate entities.

With locations in 10 states, we are able to provide career opportunities in a wide variety of settings, from bustling cities to small rural towns. At each, we offer market-driven wages, benefits and career development. Most importantly, we provide all of our employees with opportunities to grow spiritually as they further the mission of Extending the Healing Ministry of Christ.




Our Culture

What is the culture like at Adventist Health System
We have a friendly, Christian culture that inspires us to care for patients with uncommon compassion and uncompromising excellence. Because we believe that each person is created in the image of God with an inseparable connection between mind, body and spirit, our focus goes beyond treating illness toward helping people achieve optimal well-being so they can enjoy happy, healthy lives. This same philosophy of care is extended to our team members through personal interactions (team lunches, huddles, and prayer) and professional resources (ongoing education, comprehensive benefits, and employee wellness program) to help you be your best and provide the best possible care.




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