Job DescriptionThe Role You'll lead and develop a team of 10 specialists - including clinical denial nurses, coders, and underpayment/credit balance specialists - overseeing the full denials, appeals, and recovery operation. The department manages roughly $55M in denials, so your work directly protects the organization's financial health.
This role is about operational excellence and process improvement within an established, well-run department - not building from scratch. You'll be measured on what matters: denial overturn rate and cash recoveries.
Earnings $90,000-$110,000 target (up to $120,000 DOE), plus annual bonus up to 15% Relocation: Assistance available for the right candidate salary
Location - In Office Schedule - Monday-Friday, 8:00 AM-4:30 PM (onsite)
Job TypeDuties - Daily leadership of the Denials, Appeals & Recovery team
- Analyzing denial trends to identify root causes and drive recoveries
- Ensuring denied and underpaid accounts are worked timely and appropriately
- Partnering with Managed Care on payer contracts and reimbursement strategy
- Leading payer Joint Operating Committees and maintaining payer report cards
- Coaching, developing, and supporting a tenured, specialized team
Requirements - 10+ years in managed care, appeals/denials, and/or reimbursement - including 5+ years in written appeals
- Strong working knowledge of major payers - Aetna, UnitedHealthcare, and Florida Blue experience is a plus
- Hospital/health-system experience required (facility size flexible - what matters is understanding hospital insurance, reimbursement, contracts, and policies)
- Knowledge of Medicare NCD/LCD, ICD-10, CPT, DRG, HCPCS, and revenue codes preferred
License / Certification - Bachelor's degree (relevant experience may substitute year-for-year)
- CPC or CCS certification (AAPC or AHIMA)
Benefits Apply Now
