Manager Revenue Cycle Denial Management Systems

JOB DESCRIPTION

Job Title: Manager Revenue Cycle Denial Management System

Position Type: Manager

Work Setting: Hybrid

Group/Division/Team: Operations

Reports to: VP RCM

FLSA: Exempt

THE POSITION

The Manager, Revenue Cycle Denial Management Systems is a revenue cycle subject matter expert responsible for the implementation, configuration, optimization, and ongoing performance of the Waystar Denial Management platform in a high-volume healthcare environment. This role owns denial system logic, workflows, analytics, and payer-specific rules to drive denial prevention, improve resolution efficiency, and reduce revenue leakage at scale.

This position partners closely with Revenue Cycle Operations, IT, Compliance, and Analytics to translate denial trends into scalable, system-driven solutions, ensuring Waystar is fully leveraged to protect cash flow, improve revenue integrity, and modernize denial management operations.

This role is critical to advancing the organization from to proactive and automated denial remediation, data-driven denial prevention. Through strong platform governance, disciplined implementation management, and alignment of system logic with payer behavior, this role directly impacts cash flow, operational efficiency, and enterprise revenue performance.

ESSENTIAL RESPONSIBILITIES

Waystar Denial Management Platform Ownership

• Own end-to-end configuration, governance, and optimization of the Waystar Denial Management platform
• Serve as the primary internal expert on Waystar denial functionality, capabilities, enhancements, and roadmap alignment
• Design, implement, and maintain:
  • Denial reason code normalization and categorization logic
  • Payer-specific denial rules, automation, and routing logic
  • Work queues, prioritization frameworks, and resolution workflows
  • Escalation paths for high-risk, high-dollar, and systemic denial issues
• Ensure Waystar system configuration aligns with payer behavior, contract terms, regulatory requirements, and operational workflows

Implementation, Optimization & Project Management

• Lead Waystar denial management implementations, upgrades, and optimization initiatives from design through post-launch stabilization
• Act as the project owner for system enhancements, including requirements gathering, configuration design, testing, training, go-live coordination, and performance validation
• Partner with IT and Waystar to manage integrations, data flows, and platform dependencies
• Establish implementation timelines, milestones, risk mitigation plans, and success metrics
• Ensure adoption through effective change management, documentation, training, and operational handoff
• Continuously assess platform performance and identify optimization opportunities as payer behavior and business needs evolve

Denial Strategy & Prevention

• Analyze denial trends to distinguish preventable vs. non-preventable denials and quantify financial impact
• Partner with front-end, coding, billing, and clinical documentation teams to drive upstream denial prevention
• Translate root cause findings into Waystar system rules, edits, automation, and workflow changes
• Design data-driven appeals strategies, prioritization logic, and task allocation to maximize recoveries
• Proactively identify emerging payer risks and configure system defenses before denials escalate

Revenue Cycle Analytics & Performance

• Define, monitor, and continuously improve KPIs, including:
  • Overall denial rate and preventable denial rate
  • Days to denial resolution
  • Appeal success rate and turnaround time
  • Net revenue recovery
  • First-Pass Untouched Paid Rate (FPUPR)
  • Bad debt and downstream financial exposure
• Leverage Waystar analytics and enterprise reporting tools to deliver actionable, defensible insights
• Support executive reporting, business reviews, and payer strategy discussions with clear performance narratives

Cross-Functional Leadership & Governance

• Act as the central liaison between Revenue Cycle teams, IT, Compliance, and Waystar
• Establish governance standards for denial system configuration, change control, and documentation
• Support compliance initiatives by ensuring denial workflows align with payer policy, CMS guidance, and regulatory requirements
• Influence enterprise denial management strategy through data, system expertise, and operational insight

REQUIRED EXPERIENCE & QUALIFICATIONS

• Bachelor's degree in Healthcare Administration, Business, Finance, or related field required

• Master's degree preferred
• 5+ years of progressive experience in Revenue Cycle Management
• 3+ years of hands-on experience with Waystar Denial Management, including system configuration and optimization
• Experience supporting high volume claim environments (millions of claims annually)
• Proven experience reducing denial rates through system and workflow design, not just operational staffing
• Deep understanding of:
  • Claim lifecycle and payer adjudication processes
  • Denial reason codes, CARCs/RARCs, and payer-specific logic
  • Appeals workflows and prioritization strategies
• Hands-on experience configuring:
  • Rules engines
  • Work queues
  • Automation and routing logic
  • Denial analytics and dashboards
• Strong Excel and data analysis skills; BI tool experience preferred
• Experience with large national payer mixes (Commercial, Medicare, Medicaid)
• Prior ownership of denial management platform governance
• Experience working in complex, multi-state healthcare organizations
• Consulting or implementation background with Experian a plus
• Systems oriented revenue cycle thinker
• Strong analytical and problem-solving skills

COMPENTENCIES: Core to all positions at VaxCare

We Live (and Work) by Our Values:

- Building a team culture founded on trust, collaboration, and delivery excellence

- Belief in Something Bigger than Ourselves - Capacity to derive meaning from a larger purpose

- Humility as a Posture of Learning - Burning curiosity to learn without ego

- Adaptability & Embracing Change - Nimbleness & ready to seize new opportunities

Additional "Must Haves":

- Dependability - Must be able to meet deadlines, work independently, maintain focus, & punctual

- Interpersonal Skills - Builds strong relationships & contributes to a positive work environment.

- Computer Skills - Skilled with computers, learns new tools quickly.

- Ethics - Honest, accountable, maintains confidentiality.

OTHER RESPONSIBILITIES

• Commute to Office: Must be able to commute to and from the corporate office for each scheduled shift.
• Prolonged sitting or standing: Team members must be able to remain in a stationary position for extended periods, as much of the work involves sitting at a computer or workstation. Some hybrid or office-based roles may also require the ability to stand for portions of a shift.
• Repetitive motions: Significant use of the hands, wrists, and fingers is required for tasks like typing, using a computer mouse, and handling paperwork.
• Treating data engineering as a craft, with strong attention to correctness, performance, and maintainability
• Visual acuity: This job requires the ability to view a computer screen and read documents for extended periods.
• Communication: Team members must be able to clearly express and exchange ideas in English to effectively communicate with customers and co-workers.
• Occasional lifting: Many office-based jobs specify the ability to occasionally lift or move up to 10-20 pounds to handle supplies or equipment.

Physical Requirements/Work Environment:

TASK

Continuous

Intermittent

Seldom

N/A

Regular & Reliable Attendance

X

Standing/Walking

X

Travel/Driving/Operating Vehicle

X

Sitting (desk/computer work)

X

Lifting/Lowering/Carrying (up to 20lbs)

X

Reaching/Bending/Twisting

X

Hand/Wrist Use (typing/mouse/writing)

X

In person attendance for meetings/conferences

X

Operating Mobile Equipment/Machinery

X

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Note: Team Members in this position will be responsible for implementing and acting in accordance with VaxCare's information security policies; protecting assets from unauthorized access, disclosure, modification, destruction or interference; executing specific security processes or activities as assigned by the Information Security and/ or Privacy officers; and reporting security events or potential security risks to the organization. Team Members in this role will be involved in the processing of protected patient and/or payment information and will be responsible for ensuring the security and privacy of the information within their scope of work.