Description

Director of Appeals Management

Vetter Health Services, a premier provider of senior living and care with a 50-year legacy, is seeking a Director of Appeals Management to join our team. As a leader in senior care, we are committed to providing dignity and exceptional care to seniors, and we need someone passionate about driving success in managing appeals and ensuring compliance with Medicare, Medicaid, Medicare Advantage, and third-party insurance policies.

About Us

Recognized as one of the Great Places to Work, we offer an innovative, quality-driven environment where Team Members have the opportunity to grow professionally while making a positive impact on senior care. Our mission of "Dignity in Life" sets us apart as a leader in senior care services.

Position Summary
The Director of Appeals Management will play a crucial role in overseeing the appeals process for Medicare, Medicaid, Medicare Advantage, and third-party insurance claims. The ideal candidate will have extensive knowledge of healthcare regulations and a clinical background, along with a strong focus on managing and resolving claims denials.

Requirements:

Strong knowledge of Medicare, Medicaid, Medicare Advantage, and third-party insurance policies.
Clinical background with RAC-CT or equivalent experience.
Appeals and claims experience with Medicare, Medicaid, Medicare Advantage, and third-party insurance.
Excellent analytical skills to evaluate complex medical records and identify key issues.
Exceptional written and verbal communication skills to effectively present medical information during appeals hearings and interactions with stakeholders.

Key Responsibilities:

Collaborate with Financial Services/Operations teams to identify active denials and appeals related to insurance claims.
Manage the full appeal tracking process from start to finish, ensuring timely initiation, updates, and completion.
Determine, manage, and communicate the appeal response schedule.
Gather required documentation from therapy, medical records, and/or buildings for appeals.
Prepare appeal summaries and files, ensuring all required documentation is included.
Submit and track the progress of appeals through various correspondence systems (online, mail, fax).
Determine levels of appeal based on findings and manage next-level appeals if needed.
Collaborate with the clinical and reimbursement teams to identify opportunities for claims analysis and improvement.
Track and trend denials by location and across the company, identifying areas for education.
Identify managed care/regulatory compliance issues that contribute to denials and share with leadership.
Represent the company in administrative hearings, ensuring full compliance with regulations.
Stay updated on changes in Medicare and Medicaid policies, and communicate new regulations to Financial Services/Operations teams.

Why Join Our Team?

Be part of an innovative and supportive team where culture matters!
Work in a dynamic, quality and culture-driven environment with opportunities for growth and professional development.
Excellent benefits and a comprehensive work-life balance.
A recognized Great Place to Work nationally.

If you are an experienced professional in appeals management with a strong background in Medicare and Medicaid, and you are ready to contribute to the success of a leading healthcare provider, we invite you to apply today.

To apply, please visit our career center at www.vetterhealthservices.com.

Equal Opportunity Employer (EOE)

Qualifications

Qualified candidates will have two years' experience in A/R and/or Third Party Insurance billing, preferably in the area of Medicare, Medicaid, and other Commercial payers. They will have a practical understanding of functional accounting procedures, A/R, claim follow-up and collections, A/P, account reconciliation, month-end close and financial reports.