Denials Management Team Lead - Hospital Billing (HB)

Position Summary

The Revenue Cycle Denials Team Lead provides daily operational leadership, technical expertise, and escalation support for denial prevention and denial resolution activities across a multi-hospital, 100 plus practice health system. This position oversees the accuracy, timeliness, and effectiveness of complex denial workflows, including coding denials, authorization denials, technical rejections, COB/MSP, medical necessity, and payer-specific denial classifications, to reduce AR days, prevent avoidable write-offs, and accelerate cash.

The Team Lead functions as an extension of leadership by coordinating daily assignments, coaching analysts, supporting root-cause analysis, developing corrective action plans, maintaining payer knowledge, and ensuring denial workflows are accurate, compliant, and aligned with organizational goals.

Responsibilities

Operational Oversight & Workflow Coordination

• Oversee daily productivity for denial specialists, ensuring timely movement of accounts through Epic WQs (HB/PB).
• Monitor denial volumes, trends, and backlogs using Epic dashboards.
• Assign work based on denial type, payer complexity, aging, and team member skill set.
• Ensure compliance with timely filing, appeal deadlines, and payer-specific requirements.
• Review complex escalated accounts requiring clinical, coding, documentation, or contract interpretation.

Denial Classification, Analysis & Resolution

• Provide subject-matter expertise in:
  • CO-197 Authorization Denials
  • CO-50 Medical Necessity denials
  • CO-45 Contractual write-off validation
  • Coding rejections (modifiers, bundling, NCCI edits)
  • MSP/COB denials
  • Technical and billing errors
  • Prior authorization retro auths
  • Payer-specific remittance interpretation
• Conduct root-cause analysis with leadership and identify systemic issues (training gaps, coding errors, workflow failures, payer trends).
• Collaborate with Billing, Coding, PAS, Clinical Appeals, Revenue Integrity, and Managed Care to address recurring denials.

Appeals

• Ensure specialist prepare complete, accurate, and timely appeals with:
  • Clinical documentation
  • Coding support
  • Payer policy evidence
  • Contract language

Performance Monitoring, Reporting & KPI Tracking

• Track performance metrics including:
  • Denials overturn rate
  • Avoidable denial rate
  • Appeal success rate
  • Aging > 90 days
  • Write-off prevention
• Analyze payer-specific trends and present findings to leadership.
• Maintain denial prevention scorecards, dashboards, and audit tools.

Staff Coaching, Development & Training

• Provide technical coaching and daily feedback for denial specialists.
• Conduct quality reviews and assist leadership in developing improvement plans for staff.
• Train team on payer rule changes, and policy variations.
• Support onboarding, education, and cross-training.

Compliance, Quality & Regulatory Integrity

• Ensure all denial-related actions comply with:
  • Payer contracts
  • CMS regulations
  • State requirements
  • Internal policies
  • Documentation standards
• Audit staff work for accuracy, compliance, and quality documentation.
• Support internal and external audits (Medicare, Medicaid, RAC, payer audits).

Process Improvement & System Optimization

• Identify workflow gaps and recommend solutions to reduce denials at the source.
• Partner with IT/IS and Epic analysts on enhancements, rules, claim edits, and automation opportunities.
• Maintain SOPs, job aids, payer grids, and denial prevention guidelines.

Minimum Requirements

• High school diploma or GED required. 
• 3 - 5 years of hospital/professional billing, denials, or coding experience.
• At least 1 year of informal or formal leadership experience (team lead, senior representative, trainer, QA auditor, or equivalent).
• Experience with multi-hospital and multi-specialty practices.
• Strong Epic HB/PB experience required.
• Knowledge of CPT, HCPCS, ICD-10, revenue codes, modifiers, and payer reimbursement.

Preferred Qualifications

• CRCR, CPC, CPMA, or CHAM/CHAA certification.
• Deep understanding of payer contracts and clinical documentation.

Other Information

• Remote role (based out of Greenville, NC)
• Monday - Friday day shift:
  • 8:00 a.m. - 5:00 p.m.
• Great Benefits

#LI-REMOTE

#LI-AH2

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.