The Manager partners with Financial Reconciliation, Billing Operations, Payer Relations, Revenue Systems Strategy & Business Optimization, Patient Experience, Resupply, IT, and executive leadership to support enterprise revenue performance objectives.
Direct Reports: W/C Revenue Recovery & Resolution SME; Team Lead, Revenue Recovery & Resolution; Denial Strategy & Recovery Specialist; Complex Revenue Recovery Specialist; Patient Revenue Recovery Specialist
Critical Competencies- Revenue Recovery Strategy: Develops and executes recovery strategies that improve collections, reduce aging, resolve denials, and maximize recoverable revenue.
- Financial & Operational Acumen: Analyzes reimbursement trends, financial performance, payer behavior, and operational barriers to identify risks and prioritize recovery opportunities.
- Leadership & Accountability: Leads, develops, and holds teams accountable for productivity, quality, performance improvement, and consistent workflow execution.
- Payer Escalation & Resolution: Navigates complex payer, carrier, attorney, and reimbursement disputes through effective escalation, negotiation, and relationship management.
- Strategic Problem Solving & Collaboration: Identifies root causes, recommends corrective actions, and partners across operational, financial, clinical, payer, and executive stakeholders to drive sustainable improvement.
- Revenue Governance and Oversight: Leads efforts to identify and resolve internal and external revenue risks, process gaps, and operational barriers that may impact billing accuracy, reimbursement, or revenue performance. Establishes clear governance, accountability, and escalation pathways to support timely resolution and prevent recurring issues.
Essential Duties & ResponsibilitiesRevenue Recovery Leadership
- Lead recovery operations across Commercial, Workers' Compensation, Personal Injury, and other assigned reimbursement segments.
- Establish departmental recovery strategies, priorities, goals, and performance expectations.
- Ensure consistent execution of follow-up, denial management, appeal, escalation, and recovery workflows.
- Monitor and improve recovery outcomes through proactive management of team activities and performance.
Recovery Strategy & Resolution Management
- Develop recovery strategies by payer, denial category, carrier, attorney, business line, and aging segment.
- Evaluate recovery opportunities and prioritize efforts based on financial impact and probability of success.
- Review high-dollar, high-risk, complex, or escalated reimbursement issues.
- Direct resolution efforts for significant payer disputes and reimbursement barriers.
- Establish and maintain payer escalation frameworks and resolution pathways.
Denials & Appeals Oversight
- Oversee denial management and appeal activities across all recovery teams.
- Ensure timely submission of appeals, reconsiderations, corrected claims, and supporting documentation.
- Evaluate denial trends and identify opportunities for prevention and performance improvement.
- Support development of enterprise denial prevention strategies.
- Monitor appeal success rates and reimbursement outcomes.
Financial Performance Management
- Monitor recovery dollars, collections performance, AR aging, appeal outcomes, and reimbursement trends.
- Forecast recovery opportunities and financial impacts.
- Identify and communicate reimbursement risks and performance barriers.
- Develop action plans designed to improve organizational recovery performance.
- Support executive reporting and departmental scorecard development.
Team Leadership & Development
- Lead hiring, onboarding, training, coaching, and performance management activities.
- Establish productivity, quality, and accountability standards.
- Promote career development and succession planning.
- Foster a culture of ownership, problem solving, and continuous improvement.
- Support cross-training and knowledge-sharing initiatives.
Revenue Integrity & Continuous Improvement
- Analyze root causes of reimbursement failures and collaborate with operational teams to address systemic issues.
- Partner with Financial Reconciliation, Billing Operations, Payer Relations, and Revenue Systems Strategy & Business Optimization leaders to reduce future revenue leakage.
- Support system enhancements, workflow redesign, and automation initiatives.
- Evaluate effectiveness of implemented process improvement efforts.
- Contribute to enterprise revenue performance initiatives.
Documentation, Compliance & Governance
- Maintain policies, procedures, standards, and controls related to recovery operations.
- Ensure timely and accurate documentation of recovery activities and payer communications.
- Monitor compliance with regulatory requirements, payer guidelines, and internal policies.
- Support internal audits and quality assurance initiatives.
- Promote consistent recovery documentation and workflow adherence.
QualificationsRequired
- Seven (7) or more years of healthcare revenue cycle, accounts receivable, denial management, appeals, reimbursement, recovery, or collections experience.
- Three (3) or more years of people leadership experience.
- Demonstrated expertise in payer reimbursement, denial resolution, appeals, aging management, and recovery operations.
- Strong financial analysis, reporting, negotiation, communication, and problem-solving skills.
- Experience managing recovery performance metrics and operational improvement initiatives.
Preferred
- DME/HME industry experience.
- Multi-payer recovery leadership experience.
- Workers' Compensation and/or Personal Injury Reimbursement experience.
- Revenue Cycle, Compliance, Healthcare Finance, or related professional certifications.
- Experience with NikoHealth or comparable healthcare revenue cycle platforms.
Key Performance Indicators (KPIs)- Net Collection Rate
- Recovery Dollars Recovered
- Days in Accounts Receivable (AR)
- AR Greater Than 90 Days
- Appeal Success Rate
- Recovery Resolution Rate
- Denial Overturn Rate
- Avoidable Write-Off Reduction
- Team Productivity & Quality Performance
- Revenue Risk Mitigation & Recovery Forecast Accuracy
General Employment Expectations- Maintain accurate and timely documentation within NikoHealth and other approved systems.
- Follow established workflows, controls, escalation protocols, and compliance requirements.
- Meet established departmental quality, productivity, aging, and financial performance expectations.
- Participate in training, testing, implementations, project work, and continuous improvement activities.
- Maintain professional and collaborative relationships across Finance, Financial Reconciliation, Billing Operations, Patient Experience, Resupply, IT, Payer Relations, Revenue Systems Strategy & Business Optimization, and external stakeholders.
- Perform other duties as assigned consistent with the purpose and scope of the position.
