Manager, Denials Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the daily supervisory functions and operational execution of technical and coding denial management activities within the Revenue Cycle department.

• Lead a team of denial specialists and coordinators dedicated to addressing technical and coding-related claim denials across all payer types, facilities, and service lines.

• Manage daily denial work queues for technical and coding denial categories, ensuring cases are appropriately assigned, prioritized based on financial impact and deadline risk, and resolved within the timelines required by payers.

• Monitor team workload, capacity, and throughput on a daily and weekly basis; adjust case assignments and staffing as necessary to avert missed filing deadlines.

• Act as the primary escalation point for intricate technical and coding denial cases necessitating manager-level review, payer communication, or cross-functional collaboration.

• Track and report weekly team performance to the Director, including denial volumes, appeal activities, resolution rates, write-off risk, and aging by payer, denial code, and category.

• Identify systemic denial patterns or payer behavior trends within the queue and escalate to the Director, providing root cause analysis and suggested corrective measures.

• Oversee the resolution of technical denials, including timely filing, prior authorization, eligibility, coordination of benefits, duplicate billing, medical records requests, and credentialing-related claim rejections.

• Review and approve appeal submissions for high-value or complex technical denials before filing, ensuring accuracy, completeness, and the inclusion of appropriate supporting documentation.

• Collaborate with Patient Access, Provider Enrollment, Utilization Management, and Billing to trace the root causes of technical denials back to their origin and implement sustainable upstream corrections.

• Conduct structured root cause analyses on high-volume technical and coding denial categories; present findings and corrective action plans to the Director, supported by denial data.

⛳️ Requirements

• Bachelor’s degree in Health Information Management, Healthcare Administration, Business, or a related field; or an equivalent combination of education and experience.

• At least 5 years of experience in healthcare revenue cycle with a focus on denials management, claims resolution, or billing operations, including a minimum of 2 years in a lead, supervisory, or management role.

• Proven experience managing technical and coding denial queues across Medicare, Medicaid, Medicare Advantage, and commercial payer types.

• Comprehensive knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding systems and their relevance to claim adjudication, reimbursement, and coding-related denial rationales.

• Strong understanding of Medicare and Medicaid billing regulations, managed care authorization requirements, payer contract terms, and timely filing rules across major payer types.

• Familiarity with NCCI edits, modifier utilization, DRG methodology, and prevalent coding denial patterns for inpatient and outpatient service lines.

• Proficiency in major EHR and revenue cycle platforms (Epic, Cerner/Oracle Health, Meditech, or equivalent) and denial management workflow tools.

• Completion of regulatory/mandatory certifications as required.

• Willingness and capability to travel to client or organizational sites as necessary.

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off

• Flexible work arrangements

• Professional development