RCM Healthcare Claims Denials Manager

Are you a healthcare professional with a passion for managing claims denials and improving revenue cycle performance? Are you looking for an opportunity to make a positive impact on the healthcare industry? If so, Humana has the perfect role for you as our RCM Healthcare Claims Denials Manager.As the RCM Healthcare Claims Denials Manager, you will play a critical role in ensuring timely and accurate processing of healthcare claims, minimizing denials, and reducing revenue loss. This role requires a detail-oriented individual with strong leadership skills and a deep understanding of healthcare claims denials management.To be successful in this role, you must have a minimum of 5 years of experience in healthcare claims denials management, a thorough knowledge of CMS regulations and industry guidelines, and a proven track record of improving revenue cycle performance. You must also have excellent communication and problem-solving skills and the ability to work collaboratively with cross-functional teams.If you are ready to take on a challenging and rewarding role in the healthcare industry, we invite you to apply for the RCM Healthcare Claims Denials Manager position at Humana. Join our team and be a part of our mission to help people achieve lifelong well-being.

1. Oversee the management of healthcare claims denials and appeals processes for Humana, ensuring timely and accurate resolution.
2. Develop and implement strategies to minimize claim denials and reduce revenue loss.
3. Utilize in-depth knowledge of CMS regulations and industry guidelines to ensure compliance and maximize revenue.
4. Lead and motivate a team of claims denial specialists to achieve departmental goals and objectives.
5. Monitor and analyze claim denial trends, identifying root causes and implementing corrective actions.
6. Collaborate with cross-functional teams, including coding, billing, and revenue cycle management, to improve overall process efficiency and accuracy.
7. Conduct regular audits of claims denial processes and provide recommendations for improvement.
8. Serve as a subject matter expert on claims denial management, providing guidance and training to team members and other departments.
9. Communicate with internal and external stakeholders, including providers and payers, to resolve complex claims denial issues.
10. Develop and maintain policies and procedures related to claims denials management, ensuring compliance with company standards and industry regulations.
11. Stay updated on industry trends and best practices in claims denials management, and make recommendations for process enhancements.
12. Monitor and report on key performance indicators, such as denial rates and revenue recovery, to senior management.
13. Foster a culture of continuous improvement and innovation within the claims denial management team.
14. Represent Humana in meetings and negotiations with external parties related to claims denials management.
15. Provide regular updates and recommendations to senior management on the status of claims denials and strategies for improvement.

According to JobzMall, the average salary range for a RCM Healthcare Claims Denials Manager is between $70,000 - $95,000 per year. This can vary depending on location, experience, and the specific company or organization the manager works for.

Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.