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.