Senior Manager Denials Management

Job Description

Provides strategic direction for the Denials Management team to ensure operational, financial, productivity, quality, and service level agreement performance metrics are achieved, maintained, and aligned with organizational objectives.

Leads, coaches, and develops leaders and team members within the denials management downline, ensuring accountability for the quality, timeliness, and accuracy of work performed.

Safeguards accounts placed with assigned teams and vendors are worked within established service level agreements, productivity standards, quality expectations, and payer requirements.

Develops and executes action plans to improve or maintain performance, address operational gaps, and support continuous improvement across denial prevention, appeal, and recovery workflows.

Analyzes accounts receivable, denial, payer, and operational trends to identify root causes and provide actionable insights, recommendations, and interventions to improve performance.

Manages vendor relationships and vendor performance, ensuring vendors meet contractual expectations, service level agreements, quality standards, and operational objectives.

Partners with internal and external stakeholders, including revenue cycle leadership, Managed Care, payers, vendors, and operational teams, to resolve payer issues, support disputes, and deliver preeminent denial management performance.

Provides timely, accurate, and actionable data and reporting to support payer escalations, dispute resolution, performance reviews, and strategic decision-making.

Maintains expertise across the revenue cycle continuum and ensures compliance with applicable regulatory requirements, payer policies, and organizational standards.

Participates in hiring, training, performance management, succession planning, and talent development to support a high-performing denials management team.

Performs other duties as assigned

Knowledge, Skills, And Abilities

• Strong understanding of healthcare revenue cycle processes, systems, workflows, and performance drivers across the revenue cycle continuum
• Knowledge of payer policies, denial processes, appeal strategies, CPT, HCPCS, ICD coding systems, and billing regulations for government and commercial payers
• Advanced analytical and problem-solving skills with ability to interpret accounts receivable, denial, quality, productivity, and financial performance data and convert trends into actionable recommendations
• Financial acumen with ability to evaluate operational performance, identify risks and opportunities, and act on data to support key financial and operational objectives
• Operates at a Senior Manager level, achieving results through leadership of others, including managers, supervisors, and experienced professionals
• Effective leadership, coaching, team development, performance management, and talent development capabilities for leaders and teams
• Ability to manage teams that may include managers, supervisors, and experienced professionals while promoting accountability, engagement, and service excellence
• Ability to communicate clearly and professionally with diverse internal and external stakeholders, including senior leadership, Managed Care, payers, vendors, and revenue cycle partners
• Strong organizational and time management skills with ability to prioritize competing demands in a dynamic, fast-paced healthcare environment
• Proficiency in Microsoft Office applications, particularly Excel, and ability to use healthcare information systems and denial management technology platforms to monitor and improve performance
• High level of integrity and discretion in handling confidential information, sensitive business matters, payer issues, and team member information
• Experience with process improvement methodologies and ability to evaluate workflows, implement improvements, and sustain operational efficiencies

Education

• Bachelor's degree [Required]
• Master's degree [Preferred]
• Field of study: In Business, Healthcare, Health Services Administration, Health Information Management, Communications, Finance, Accounting, Public Administration, Human Resources, Management, or Marketing

Work Experience

• 3+ years Revenue Cycle experience [Required]
• 3+ years leadership experience [Required]

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 3+ years of relevant work experience [Required]
• OR
• Associates degree AND 5+ years of relevant work experience [Required]
• OR
• 7+ years of relevant work experience [Required]

Licenses And Certifications

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

Physical Requirements

View physical requirements

Pay Range

$96,266.14 - $179,045.63