Manager, Denial Management

Overview: Lead denial management operations for both Hospital (HB) and Professional (PB) billing to identify, appeal, and prevent denied claims, recover revenue, and improve claim acceptance rates. Drive root-cause analysis, payer strategy, cross-functional remediation, and performance reporting to reduce denial volumes, aging, and financial impact. Qualifications:

Education: Associate degree in Healthcare Administration, Healthcare Management, or a related field highly preferred.

Experience: Minimum of 3 to 4 years of progressive revenue cycle experience, including at least 1 to 2 years in billing operations (HB and/or PB) within a hospital or multi-site health system with a two-year degree.

• Minimum of 3 years of supervisory experience in hospital and/or professional billing operations.
• A formal degree may be substituted with 6+ years of direct, hands-on revenue cycle and supervisory experience.
• Demonstrated experience with Epic and revenue cycle technologies.
• Proven success leading teams through organizational change and process improvement initiatives.
• License/Certification/Registration: Not required.

• Strong analytical skills with experience in:

• Root-cause analysis
• Data interpretation
• Data-driven decision making
• Operational problem solving

• Deep knowledge of:

• Payer rules and reimbursement requirements
• CPT and ICD coding impacts on denials
• Clinical documentation practices
• Coverage determination and authorization workflows

• Revenue cycle denial drivers and resolution strategies

• Proven leadership, coaching, and performance management abilities.
• Excellent written and verbal communication skills.
• Strong stakeholder management capabilities with the ability to collaborate effectively across departments and organizational levels.

• Experience implementing:

• Process improvement initiatives
• Workflow optimization strategies

• Automation solutions within complex healthcare environments

• High attention to detail and strong organizational skills.

• Demonstrated commitment to:

• Regulatory compliance
• Audit readiness
• Operational excellence
• Continuous improvement
• Solid problem-solving, communication, organizational, and interpersonal skills.