Senior Manager- Denials Management Operations
Senior Manager- Denials Management Operations
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Job Description
The Senior Manager Denials Management Operations plays a critical leadership role in the execution and performance of daytoday denial management activities across a large enterprise health system. This position oversees multiple specialized teams responsible for managing incoming priority and resolutionstage denials ensuring optimal performance in alignment with organizational goals and compliance requirements.
The ideal candidate brings strong operational leadership the ability to manage multiskilled teams and a firm grasp of key revenue cycle KPIs. The Senior Manager will also collaborate closely with PRIZM teams to align on denial trends provide feedback loops and contribute to datainformed performance improvement. Additionally this role will be a key point of contact for teams working with external global vendors ensuring quality efficiency and accountability.
Key Responsibilities:
- Direct daily operations of denials management teams including those focused on new incoming denials priority denials and denial resolution.
- Manage a team of Senior Representatives and Representatives across multiple functions and locations.
- Ensure departmental and enterprise KPIs are tracked met and continuously improved (e.g. denial overturn rates days to resolve appeal success rates).
- Partner closely with the PRIZM team to monitor denial trends identify feedback loops and guide datadriven improvements.
- Provide frontline feedback on denial patterns to upstream departments including clinical documentation patient access and billing teams.
- Collaborate with enterprise vendor management teams and global service providers to align on operational execution productivity and quality expectations.
- Develop team performance metrics conduct regular reviews and implement performance improvement strategies where necessary.
- Ensure all activities are compliant with payor guidelines organizational standards and applicable regulatory requirements.
- Act as a coach and mentor to staff fostering growth and engagement through ongoing development and feedback.
- Maintain a strong operational rhythm with crossfunctional stakeholders ensuring escalation pathways are in place and effectively utilized.
- Support broader revenue cycle initiatives participating in committees task forces or workgroups as needed.
Qualifications
Required:
- Bachelors degree in Business Healthcare Finance or related field and 10 years of relevant experience including 5 years of leadership experience
OR
14 years of relevant experience in lieu of a degree including at least 5 years managing people and operations. - Proven ability to manage highvolume operational teams in a complex healthcare environment.
- Deep understanding of denial workflows appeals root cause analysis and operational KPIs.
- Demonstrated success managing people driving performance improvement and optimizing team structures.
- Experience working in or closely with revenue cycle systems including denial management platforms like PRIZM.
- Excellent communication and relationshipbuilding skills across administrative clinical and vendor teams.
Preferred:
- Experience managing multisite or remote teams including global vendor operations.
- Familiarity with EPIC and other denial and appeal tracking tools.
- Prior work in a large academic health system or matrixed health enterprise.
- Involvement in denial prevention workgroups HFMA task forces or payerprovider collaboration initiatives.
Key Competencies:
- Operational Execution & Prioritization
- Team Leadership & Talent Development
- MetricsDriven Accountability
- Stakeholder Coordination & Feedback Loop Creation
- Vendor Oversight & Partnership Management
- Revenue Cycle Process Knowledge
- Strong Communication & Situational Awareness
Additional Information:
- This position may require occasional travel based on operational needs or vendor coordination.
- Ability to operate in a fastpaced performancedriven environment with rapidly changing priorities.
Required Experience:
Senior Manager
Employment Type
Full-Time
