Position Summary:

The Director of Denials Management is responsible for developing and leading enterprise-wide denial prevention, appeals, and recovery strategies across the Revenue Cycle Management organization. This role will establish standardized appeals processes, payer-specific appeal templates, denial workflows, and operational best practices designed to maximize reimbursement, improve overturn rates, and reduce avoidable write-offs.Initially, the Director will focus on process design, workflow standardization, governance, and cross-functional collaboration. Over time, the role will assume leadership of denial and appeals personnel supporting centralized denial management functions. This position serves as a key liaison between Revenue Cycle Operations, Clinical Leadership, Medical Necessity Review, Managed Care, Compliance, and Executive Leadership to ensure a coordinated and effective approach to denial resolution and reimbursement recovery.

Denials Strategy

·Develop and implement a comprehensive denials management strategy across the organization.

·Establish enterprise standards for denial identification, categorization, escalation, appeal submission, and resolution.

·Create governance structures to ensure consistent denial management practices across all business units and regions.

·Identify trends and root causes contributing to denials and develop corrective action plans.

Appeals Program Development

• Design and maintain payer-specific appeal templates and supporting documentation requirements.
• Standardize appeal letter language, workflows, and submission processes.
• Create appeal playbooks for common denial categories including medical necessity, authorization, coding, billing, bundling, timely filing, and payer policy denials.
• Develop tracking mechanisms to monitor appeal success rates and recovery outcomes.
  
  

Workflow Optimization

• Evaluate current denial and appeals workflows and implement process improvements.
• Create standardized operating procedures and work instructions.
• Partner with operational leaders to reduce variation and improve consistency across teams.
• Collaborate with technology and reporting teams to enhance denial tracking and workflow automation.

Cross-Functional Collaboration

• Partner closely with Medical Necessity Appeals leadership and physician advisors to coordinate clinical appeals strategies.
• Work collaboratively with Coding, Patient Access, Utilization Review, Billing, Managed Care, and Operations teams to address root causes of denials.
• Support payer escalation efforts and participate in discussions related to reimbursement disputes and policy interpretation.
• Partner with Revenue Cycle Analytics teams to monitor denial trends, appeal outcomes, recovery performance, and process improvement opportunities.
• Utilize reporting and operational data to identify denial reduction and reimbursement recovery strategies

Requirements:

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Nursing, Health Information Management, or related field required.
• Master's degree preferred.
• 7+ years of progressive Revenue Cycle leadership experience.
• 5+ years of direct experience in denials management, appeals, reimbursement, or revenue integrity.
• Demonstrated experience developing denial management strategies and appeals programs.
• Strong knowledge of commercial payer reimbursement methodologies, medical necessity requirements, authorization processes, and appeals regulations.
• Experience leading process improvement initiatives across multiple facilities or business units preferred.
• Expert knowledge of denial management and appeals best practices.
• Strong analytical and problem-solving skills.
• Ability to influence leaders across multiple departments without direct authority.
• Excellent written communication skills with experience drafting appeal narratives and executive-level communications.
• Strong project management and change management capabilities.
• Advanced proficiency in revenue cycle reporting and data analysis.