DescriptionDenial & Appeals ManagerRevenue Integrity | Howard University HospitalPosition SummaryHoward University Hospital is seeking an experienced
Denial & Appeals Manager to lead denial prevention, appeals management, utilization review oversight, and revenue integrity initiatives. This position is responsible for coordinating denial and reimbursement activities, managing utilization review processes, ensuring timely appeals submissions, and partnering with clinical, financial, and operational teams to optimize reimbursement and reduce revenue loss. The manager serves as a key resource for denial mitigation, compliance, and revenue cycle improvement efforts.
Essential Responsibilities- Lead the denials and appeals process for inpatient and outpatient accounts, ensuring timely review, documentation, and follow-up.
- Coordinate resolution of escalated billing, reimbursement, and denial-related issues.
- Review clinical documentation and supporting records to facilitate successful appeal outcomes.
- Maintain accurate records related to authorization activity, utilization review, denial management, and appeal outcomes.
- Monitor insurance and authorization activity and maintain required tracking logs and reporting.
- Collaborate with physicians, clinical leadership, case management, patient access, coding, billing, and revenue cycle teams to address reimbursement challenges.
- Conduct research, audits, reviews, and assessments related to compliance, reimbursement integrity, and operational performance.
- Support internal audit, risk management, and regulatory compliance initiatives.
- Respond to inquiries regarding account status and reimbursement matters within established timelines.
- Train, mentor, and support staff involved in denial management and reimbursement integrity activities.
- Prepare and distribute reports related to denial trends, utilization review activities, and operational performance.
- Identify process improvement opportunities that enhance reimbursement outcomes and revenue cycle performance.
Required Qualifications- Bachelor's degree from an accredited college or university preferred.
- Minimum of five (5) years of healthcare, hospital revenue cycle, claims processing, reimbursement, collections, utilization review, or related management experience.
- Previous leadership or supervisory experience preferred.
- Strong knowledge of revenue cycle operations, denial management, appeals processes, and payer requirements.
- Experience working in a hospital or acute care healthcare environment.
Pay + SchedulePay Range: $85.5K - 96K
FLSA Status: Exempt
Schedule: (Monday-Friday); 8:00am - 4:30pm
