Manager, Denials Operations

Role Overview

• Responsible for day-to-day supervisory oversight and operational execution of technical and coding denial management functions within the Revenue Cycle department.
• Lead a team of denial specialists and coordinators focused on resolving technical and coding-related claim denials across all payer types, facilities, and service lines.
• Manage daily denial work queues for technical and coding denial categories, ensuring cases are assigned, prioritized by financial impact and deadline risk, and resolved within payer-required timelines.
• Monitor team workload, capacity, and throughput on a daily and weekly basis; adjust case assignments and staffing allocation to prevent missed filing deadlines.
• Serve as the first-line escalation point for complex technical and coding denial cases that require manager-level review, payer contact, or cross-functional coordination.
• Track and report weekly team performance to the Director including denial volumes, appeal activity, resolution rates, write-off risk, and aging by payer, denial code, and category.
• Identify systemic denial patterns or payer behavior trends in the queue and escalate to the Director with root cause analysis and recommended corrective actions.
• Oversee resolution of technical denials including timely filing, prior authorization, eligibility, coordination of benefits, duplicate billing, medical records requests, and credentialing-related claim rejections.
• Review and approve appeal submissions for high-dollar or complex technical denials prior to filing, ensuring accuracy, completeness, and appropriate supporting documentation.
• Partner with Patient Access, Provider Enrollment, Utilization Management, and Billing to trace technical denial root causes back to the point of origin and drive sustainable upstream corrections.
• Conduct structured root cause analyses on high-volume technical and coding denial categories; present findings and corrective action plans to the Director with supporting denial data.

Requirements

• Bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field; or an equivalent combination of education and experience.
• Minimum 5 years of experience in healthcare revenue cycle with a focus on denials management, claims resolution, or billing operations, including at least 2 years in a lead, supervisory, or management role.
• Demonstrated experience managing technical and coding denial queues across Medicare, Medicaid, Medicare Advantage, and commercial payer types.
• Working knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding systems and their relationship to claim adjudication, reimbursement, and coding-related denial rationale.
• Solid understanding of Medicare and Medicaid billing regulations, managed care authorization requirements, payer contract terms, and timely filing rules across major payer types.
• Familiarity with NCCI edits, modifier usage, DRG methodology, and common coding denial patterns for inpatient and outpatient service lines.
• Proficiency with major EHR and revenue cycle platforms (Epic, Cerner/Oracle Health, Meditech, or equivalent) and denial management workflow tools.
• Completion of regulatory/mandatory certifications as required.
• Willingness and ability to travel to client or organizational sites as needed.

Tech Stack

• Oracle

Benefits

• health insurance
• retirement plans
• paid time off
• flexible work arrangements
• professional development