GENERAL SUMMARY:

Reports to the Chief Utilization Officer (CUO) of Henry Ford Health, responsible for Clinical Denial Recovery Unit (CDRU) operations . Responsible for strategic and operational leadership and oversight of programs and initiatives including denials management, performance improvement, regulatory, compliance, and risk with an expectation of national top decile performance. This system role includes physician oversight and clinical input for post-discharge medical necessity denials at all HFHS acute care facilities .
PRINCIPLE DUTIES AND RESPONSIBILITIES:

1. Oversee a comprehensive value-driven centralized denial management process.

2. In collaboration with executive and administrative partners, provide clinical expertise to CDRU, Payor Audit, hospital UM teams, system IPAS, managed care contracting, and legal.

3. Participate as a clinical expert in payer negotiations and escalations, Accounts Receivable ...