Director of Denials and Follow-Up Management

• The Director of Denials and follow-up is responsible for the strategic oversight, operational management, and financial performance of the organization's accounts receivable management, denial prevention, appeal, and recovery efforts. This role partners closely with Revenue Cycle, Billing, Patient Access, Managed Care, Clinical, Coding, CDI, Utilization Management, and Payer Relations to reduce avoidable denials, optimize appeal success, and improve net revenue realization across all payers.
• The Director serves as the system-level leader for follow-up and denial strategy, collections, analytics, payer escalation, and continuous improvement initiatives, ensuring alignment with payer contracts, regulatory requirements, and internal clinical and financial priorities.
• This director's scope includes an understanding of the entire healthcare delivery industry, an analysis of industry changes impacting the industry clinically and financially, how those impact Premier Health directly, and an understanding of Premier's strategic plan. This position is a subject matter expert in coordinating clinical and financial principles across the continuum of care. The marriage of these concepts facilitates cost effective patient care, insures optimal clinical resource utilization, and ensures compliant payment for that care. Accomplishing that requires the management of multiple priorities and projects with tact and diplomacy, the ability to adapt quickly to change, effect change, meet business goals, monitor progress, and coordinate efforts across multiple stakeholders on both the clinical and financial fronts.

Education

Minimum Level of Education Required: Master's degree

Additional requirements:

• Type of degree: Bachelors degree, Masters in nursing, business, healthcare administration or healthcare related field preferred.

• Area of study or major: Nursing, business, healthcare administration, healthcare related field

Experience

Minimum Level of Experience Required: 7 - 10 years of job related experience

• 7-10 years of progressive experience in healthcare revenue cycle, denials management, managed care, or related functions.

• Demonstrated experience leading denial reduction and appeal strategies in a complex healthcare environment.

• Strong understanding of payer contracts, authorization requirements, medical necessity criteria, and reimbursement methodologies.

• Proven ability to work cross-functionally with clinical and non-clinical leaders.

Preferred

• Master's degree (MHA, MBA, MSN, or similar).

• Experience in a multi-hospital or integrated health system.

• Clinical background (RN or similar) or significant experience leading clinical and technical denials teams.

• Experience with denial analytics tools and EHR-based workflows.

• Functional knowledge of revenue cycle processes including surprise billing, ABN/HINN letters, LCD/NCD criteria, charging, coding, reimbursement, DRG/APCs, billing, and back- end collections is required.