Associate Director, Billing Strategy - Denials & Appeals
New
J
JobgetherHealthcare revenue cycle
Based in United StatesFull-TimeDirector
Salary132,100 - 165,100 USD per year
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Job Details
- Experience
- 8–12+ years of healthcare Revenue Cycle Management experience
- Required Skills
- SQLMicrosoft Power BISnowflake
Requirements
- Have 8–12+ years of healthcare Revenue Cycle Management experience, with deep specialization in denials and appeals.
- Bring expertise in laboratory billing, CPT coding, reimbursement methodologies, medical necessity, and payer-specific requirements.
- Know commercial, Medicare, Medicaid, and managed care payer policies and practices.
- Demonstrate success improving appeal overturn rates, resolving medical necessity denials, reducing denial drivers, and improving reimbursement outcomes.
- Have experience managing or partnering with BPO and offshore RCM vendors, including performance oversight, quality management, and operational improvement.
- Have hands-on analytical experience using Power BI, Excel, SQL, and/or Snowflake to analyze operational and financial data.
- Demonstrate the ability to lead complex cross-functional initiatives and influence stakeholders without direct authority.
- Bring experience supporting revenue cycle automation initiatives such as rules engines, RPA, or workflow automation; this experience is preferred.
- Have experience partnering with engineering teams or technology vendors to implement billing system enhancements and translate processes into system requirements; this experience is preferred.
- Bring familiarity with AI-driven operational workflows, including intelligent routing and decisioning; this familiarity is preferred.
- Have experience with AMD or similar billing platforms, and familiarity with Jira or comparable workflow tracking systems; preferred.
Responsibilities
- Lead denial management and appeals strategy across commercial, Medicare, Medicaid, managed care, and other payer environments.
- Define and monitor KPIs including appeal overturn rates, appeal timelines, recovery performance, denial rates, and financial impact.
- Interpret payer policies and guide internal and outsourced teams on medical necessity and complex denials.
- Analyze payer behavior and denial patterns to identify systemic issues and inform payer advocacy, contracting, and escalation strategies.
- Partner with eligibility, prior authorization, coding, billing, and other revenue cycle functions to reduce preventable denials.
- Oversee outsourced RCM and BPO performance, identify workflow gaps, and drive operational improvements.
- Develop standardized workflows, job aids, and operating practices for denial and appeal activities.
- Translate denial and appeals processes into system requirements and logic, and define requirements for billing-platform workflows and automation.
- Lead user acceptance testing and quality assurance for system changes, validating automated outputs against payer policies and denial scenarios.
- Use Power BI, SQL, Excel, and Snowflake to analyze denial drivers, trends, and financial impact.
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