Denials Management Director

Job Description

Provides strategic leadership for denial management operations across the system
Develops and implements policies, procedures, and performance standards for denial investigation and appeals
Oversees denial trend analysis and implements prevention strategies
Manages payer relationships and escalates complex denial issues as appropriate
Ensures compliance with all regulatory requirements and accreditation standards
Develops and monitors key performance indicators for denial management
Leads, mentors, and develops denial management staff across multiple teams
Collaborates with revenue cycle leadership on strategic initiatives and process improvements
Prepares and presents reports on denial performance to executive leadership
Manages departmental budget and resource allocation
Partners with IT and analytics teams to optimize denial management systems and reporting
Performs other duties as assigned

Knowledge, Skills, And Abilities

• Comprehensive understanding of revenue cycle processes including charge capture, billing, and reimbursement
• Extensive knowledge of CPT, HCPCS, ICD coding systems, and billing regulations for government and commercial payers
• Expert knowledge of payer policies, denial processes, and appeal strategies
• Strong leadership skills with ability to develop and manage high-performing teams
• Excellent analytical skills with ability to interpret complex data and drive strategic decisions
• Strong written and verbal communication skills with ability to present to executive leadership
• Proficiency in Microsoft Suite applications and healthcare information systems
• Ability to build collaborative relationships across organizational boundaries
• Knowledge of healthcare compliance and regulatory requirements
• Proficiency with Epic EHR system
• Experience with Six Sigma, Lean, or other process improvement methodologies
• Experience with payer contract negotiations related to denials
• Experience with denial management technology platforms and analytics tools

Education

• Bachelor's [Required]
• Master's [Preferred]

Field Of Study in finance, accounting or healthcare administrative field

Work Experience

• 5+ years of progressive leadership experience in healthcare revenue cycle operations, patient financial services, patient access management, or related healthcare financial operations [Required]
• 8+ years of progressive leadership experience in healthcare receivables, patient financial services, or revenue cycle operations within a complex healthcare environment. [Preferred]

Additional Information

• An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:
• Bachelor's Degree AND 5+ years of related work experience [Required]
• OR Associate's Degree AND 7+ years of related work experience [Required]
• OR 9+ years of related work experience [Required]

Licenses And Certifications

• Healthcare Financial Management Association (HFMA) [Preferred]
• Certified Revenue Cycle Rep (CRCR) [Preferred]

Physical Requirements

Click here to view work requirements

Pay Range

$110,702.15 - $205,911.28