Schedule: Full time
Shift: Day (United States of America)
Address: 2600 LUCIEN WAY
City: MAITLAND
State: Florida
Postal Code: 32751
Job Description: - Provides strategic direction for the Denials Management team to ensure operational, financial, productivity, quality, and service level agreement performance metrics are achieved, maintained, and aligned with organizational objectives.
- Leads, coaches, and develops leaders and team members within the denials management downline, ensuring accountability for the quality, timeliness, and accuracy of work performed.
- Ensures accounts placed with assigned teams and vendors are worked within established service level agreements, productivity standards, quality expectations, and payer requirements.
- Develops and executes action plans to improve or maintain performance, address operational gaps, and support continuous improvement across denial prevention, appeal, and recovery workflows.
- Analyzes accounts receivable, denial, payer, and operational trends to identify root causes and provide actionable insights, recommendations, and interventions to improve performance.
- Manages vendor relationships and vendor performance, ensuring vendors meet contractual expectations, service level agreements, quality standards, and operational objectives.
- Partners with internal and external stakeholders, including revenue cycle leadership, Managed Care, payers, vendors, and operational teams, to resolve payer issues, support disputes, and deliver preeminent denial management performance.
- Provides timely, accurate, and actionable data and reporting to support payer escalations, dispute resolution, performance reviews, and strategic decision-making.
- Maintains expertise across the revenue cycle continuum and ensures compliance with applicable regulatory requirements, payer policies, and organizational standards.
- Participates in hiring, training, performance management, succession planning, and talent development to support a high-performing denials management team.
- Performs other duties as assigned
Knowledge, Skills, and Abilities: - Strong understanding of healthcare revenue cycle processes, systems, workflows, and performance drivers across the revenue cycle continuum [Required]
- Knowledge of payer policies, denial processes, appeal strategies, CPT, HCPCS, ICD coding systems, and billing regulations for government and commercial payers [Required]
- Advanced analytical and problem-solving skills with ability to interpret accounts receivable, denial, quality, productivity, and financial performance data and convert trends into actionable recommendations [Required]
- Financial acumen with ability to evaluate operational performance, identify risks and opportunities, and act on data to support key financial and operational objectives [Required]
- Operates at a Senior Manager level, achieving results through leadership of others, including managers, supervisors, and experienced professionals [Required]
- Effective leadership, coaching, team development, performance management, and talent development capabilities for leaders and teams [Required]
- Ability to manage teams that may include managers, supervisors, and experienced professionals while promoting accountability, engagement, and service excellence [Required]
- Ability to communicate clearly and professionally with diverse internal and external stakeholders, including senior leadership, Managed Care, payers, vendors, and revenue cycle partners [Required]
- Strong organizational and time management skills with ability to prioritize competing demands in a dynamic, fast-paced healthcare environment [Required]
- Proficiency in Microsoft Office applications, particularly Excel, and ability to use healthcare information systems and denial management technology platforms to monitor and improve performance [Required]
- High level of integrity and discretion in handling confidential information, sensitive business matters, payer issues, and team member information [Required]
- Experience with process improvement methodologies and ability to evaluate workflows, implement improvements, and sustain operational efficiencies [Required]
Education: - Bachelors degree [Required]
- Masters degree [Preferred]
Field of Study: - In Business, Healthcare, Health Services Administration, Health Information Management, Communications, Finance, Accounting, Public Administration, Human Resources, Management, or Marketing
Work Experience: - 3+ years Revenue Cycle experience [Required]
- 3+ years leadership experience [Required]
Additional Information: - An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:
- Bachelors degree AND 3+ years of relevant work experience [Required] OR
- Associates degree AND 5+ years of relevant work experience [Required] OR
- 7+ years of relevant work experience [Required]
Licenses and Certifications: - Healthcare Financial Management Association (HFMA) [Preferred]
- Certified Revenue Cycle Rep (CRCR) [Preferred]
Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/23km2677
Pay Range:$96,266.14 - $179,045.63
