The Director, Clinical & DRG Denials provides clinical leadership and administrative guidance to the Clinical Revenue Cycle department. Directs performance improvement initiatives, develops and maintains operational policies for the department and assures regulatory compliance is a priority. Specifically, develops strategies and tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the development and implementation of policies and procedures.
The Director, Clinical & DRG Denials will work collaboratively with physicians, nursing staff, Quality, Finance and others to develop, implement and maintain strategies that capitalize on facility and industry best practices to achieve targeted outcomes.
Identifies, communicates and holds staff accountable for performance expectations; monitors/appraises the job results/performance and promotes a positive, team-oriented work environment. Develops relationships and influences payer policies and procedures as well as facilitating strong working relationships between HIM, Clinical Documentation, UR, Physician Advisor operations, PFS, Contracting, and hospital departments and leadership to promote effective clinical validation improvement and clinical denial management system-wide. Significant influence on system quality and financial outcomes.
**Buffalo, NY**