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POSITION TITLE:
AVPDenials- Management and Prevention









Position Description:
The AVP of Denial Management and Prevention is responsible fordirecting and administering the operations, programs, and activities of a centralized denial recovery operation, ensuring that processes and data meet regulatory requirements and policies.






Primary Roles and Responsibilities:







Directs, manages and oversees processes and protocols to ensure accurate DENIAL rebilling and follow-up collections processes are followed. Responsible for understanding complexities involved in supporting denialactivities spanning multiple states, across all assigned clients, payer environments, and technologies to direct teams accordingly.










Reviews and analyzes data to access operational services and determine need for changes. Oversees and manages the development and communication of policies/procedures and other business documentation, as well as the development and implementation of special projects, studies and initiatives. Develops and manages plans of action for those areas not meeting expectations.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Compliance Program, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.







Provides leadership to and actively participates with facility staff to identify, implement, or enhance denial prevention programs consistent with division strategy.

Conducts trend analysis from various data sources such as denial reports, audit results, and other information to assist in identifying gaps and developing program components to mitigate identified gaps at root cause.

Serves as a subject matter expert and serves as an internal consultant to multiple clients and physician offices in denial prevention.

Engages with individual client to identify unique concerns and assists with the identification of strategies for denial prevention and the development of facility action plans.

Responsible for immediate intervention to assist facilities in denial prevention.













Firstsource in the Healthcare Provider space







Digitally Empowered, Intelligent Backoffice, Platform Automation & Analytics

Global footprint with 1000+ hospitals in the US

Leader in Payer Digital Transformation Services and Rising Star in Payer BPaaS Services in ISG Provider Lens 2021




Ranked as Top Business Process Services (BPS) provider in BPS Top 50 Report and Top 10 Service Providers by Growth by Everest Group

Top 3 BPO in the chosen Revenue Cycle Management segments in US Healthcare

Full suite Healthcare Provider related offerings, designed to meet clients needs

More than 5,481 employees in the US with 21 centers