Premier Health Partners

Director of Denials and Follow-Up Management

Premier Health Partners • $110K — $130K *
Dayton, OH 45424In-Person
Healthcare
5 - 7 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Master's degree in nursing, business, healthcare administration or related field preferred.
  • 7-10 years of experience in healthcare revenue cycle and denials management.
  • Demonstrated leadership in denial reduction and appeal strategies.
  • Strong understanding of payer contracts and medical necessity criteria.
  • Proven ability to collaborate with clinical and non-clinical leaders.

Responsibilities

  • Oversee accounts receivable management and denial prevention efforts.
  • Develop strategies to optimize appeal success and net revenue realization.
  • Collaborate with various departments to align operational practices with payer requirements.
  • Lead initiatives for denial strategy, collections, and analytics.
  • Manage continuous improvement efforts in financial performance and compliance.

Benefits

  • Collaborative working environment with multidisciplinary teams.
  • Opportunities for continuous learning and professional development.
  • Exposure to strategic decision-making in a healthcare delivery system.
  • Ability to influence organizational practices and enhance patient care.
  • Impactful role in managing financial performance across multiple healthcare services.
Full Job Description
  • 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.

About Premier Health Partners

Premier Health Partners is a healthcare system that provides a range of services to patients in Ohio and Indiana. The system includes four hospitals, a network of primary and specialty care practices, and a range of other healthcare services. Premier Health Partners is committed to providing high-quality, patient-centered care, and has been recognized for its clinical excellence and patient safety. The system is also involved in research and education, and works to improve the health of the communities it serves.
Learn more about Premier Health Partners
Size
14,000 employees
Industry
Healthcare
Founded
1995
* Ladders Estimates

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