About the role
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.
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