Director Denial Resource Center

Location: Dallas, Texas US

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Requisition Number: 19013630

Position Title:

External Description:

This position is responsible for the planning, developing and implementing the appeals processes for the Denial Resource Center.  This includes staffing, daily operations, budget oversight and creation of an effective support team to meet the goals and objectives of the department.  The Director will work in conjunction with the System Director Clinical Resource Management to establish policies/procedures and performance indicators for effective management of these processes.  This includes the development of management reports for senior leadership, hospital senior leaders and senior medical staff.

Knowledge, Skills and Abilities:

-Computer skills, including working knowledge of Excel

-Working knowledge of payer NCDs, LCDs, Medicare Guidelines, InterQual or equivalent evidence based criteria for hospital admission

-Working knowledge of process improvement, project management processes and tools

-Experience leading teams working in the appeals processes related to claim denials.


  • Directs daily operations of the DRC including budget, staffing, recruitment, performance management, training and special projects
  • Develops departmental policies and procedures, work flows, and staffing plans
  • Monitors departmental performance indicators and identifies opportunities for improving processes
  • Provides daily supervision of leaders and staff and ensures all areas have adequate support
  • Establishes and monitors departmental goals and objectives that are consistent with BSWH strategy, values, ambitions and mission
  • Develops and maintains reports to monitor staff performance
  • Provides comparative reports from departmental software applications as requested
  • Establishes and monitors productivity and/or performance reports for departmental operations
  • Develops and maintains management reports for senior leadership, hospital senior leaders and senior medical staff
  • Trends related denials from all payers
  • Ensures denial trends are tracked and reported to affected department leadership
  • Prepare reports/trends for managed care department reflecting payer performance
  • Actively participates in initiatives and meetings related to Clinical Resource Management
  • Serves as a resource to senior leadership, hospital senior leaders and medical staff for functions related to the appeals process
  • Maintains oversight for contracted services that support the DRC
  • Performs other positions appropriate duties as required in a competent, professional and courteous manner.
  • Meets with department, facility and corporate leaders to share identified denial prevention opportunities.

  • Benefits - Our competitive benefits package includes*:
    • Immediate eligibility for health and welfare benefits
    • 401(k) savings plan with dollar-for-dollar match up to 5%
    • Tuition Reimbursement
    • PTO accrual beginning Day 1
*Note: Benefits may vary based upon position type and/or level.
 
Baylor Scott & White Health (BSWH)  is the largest not-for-profit health care system in Texas and one of the largest in the United States.  With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation�s exemplary health care organizations.  Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it�s accepting a calling!
 
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  • Bachelors degree required
  • Master's degree preferred
  • 5+ years of related work experience
  • Registered Nurse (RN) license in Texas required
  • Clinical practice experience

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Community / Marketing Title: Director Denial Resource Center

Company Profile:

Location_formattedLocationLong: Dallas, Texas US

CountryEEOText_Description: We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. To view the most recent EEO is the Law Poster, click here.

As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviors that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products.

We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. To view the most recent EEO is the Law Poster, click here.