HealthTrackRx
Director Of Denials Management
The Director of Denials Management is responsible for leading the strategic and operational management of all payer denials for a high-volume diagnostic laboratory processing over 2 million samples annually. This individual will oversee the resolution of denied claims, root cause analysis, payer appeal processes, and prevention strategies. The Director will work cross-functionally with coding, billing, compliance, and client services to reduce denial rates and optimize reimbursement. Essential Responsibilities/Duties: Lead a team to ensure timely and effective denial resolution. Establish team goals, KPIs, and performance expectations aligned with revenue recovery targets. Analyze denial trends across commercial and government payers; identify root causes and high-risk patterns. Prioritize high-impact denials and develop mitigation strategies. Maintain dashboards and reporting for internal stakeholders and executive leadership. Oversee development of payer-specific appeal strategies and templates. Ensure all appeals are compliant, well-documented, and submitted within payer timelines. Partner with coding, client services, LIS, and front-end registration teams to prevent future denials. Coordinate with contracting teams to resolve reimbursement discrepancies tied to payer rules. Ensure denials management processes comply with CMS, OIG, and payer-specific regulations. Stay current with changes in payer guidelines, including MUEs, NCCI edits, and LCD/NCD policies. Qualifications: Education Bachelor's degree in healthcare administration, finance, business, or related field required. Competencies/Skills Expert knowledge of CPT, ICD-10, HCPCS coding, and denial codes (CO, PR, MA, etc.). Familiarity with payer portals, appeals workflows, and EMR/LIS systems. Excellent analytical, organizational, and communication skills. Proficiency in Excel and data reporting tools (Tableau, Power BI, or similar). Experience Minimum 710 years of experience in revenue cycle or denials management, with at least 2 years in a supervisory or leadership role. Experience in a laboratory or diagnostic testing environment highly preferred.
The Director of Denials Management is responsible for leading the strategic and operational management of all payer denials for a high-volume diagnostic laboratory processing over 2 million samples annually. This individual will oversee the resolution of denied claims, root cause analysis, payer appeal processes, and prevention strategies. The Director will work cross-functionally with coding, billing, compliance, and client services to reduce denial rates and optimize reimbursement. Essential Responsibilities/Duties: Lead a team to ensure timely and effective denial resolution. Establish team goals, KPIs, and performance expectations aligned with revenue recovery targets. Analyze denial trends across commercial and government payers; identify root causes and high-risk patterns. Prioritize high-impact denials and develop mitigation strategies. Maintain dashboards and reporting for internal stakeholders and executive leadership. Oversee development of payer-specific appeal strategies and templates. Ensure all appeals are compliant, well-documented, and submitted within payer timelines. Partner with coding, client services, LIS, and front-end registration teams to prevent future denials. Coordinate with contracting teams to resolve reimbursement discrepancies tied to payer rules. Ensure denials management processes comply with CMS, OIG, and payer-specific regulations. Stay current with changes in payer guidelines, including MUEs, NCCI edits, and LCD/NCD policies. Qualifications: Education Bachelor's degree in healthcare administration, finance, business, or related field required. Competencies/Skills Expert knowledge of CPT, ICD-10, HCPCS coding, and denial codes (CO, PR, MA, etc.). Familiarity with payer portals, appeals workflows, and EMR/LIS systems. Excellent analytical, organizational, and communication skills. Proficiency in Excel and data reporting tools (Tableau, Power BI, or similar). Experience Minimum 710 years of experience in revenue cycle or denials management, with at least 2 years in a supervisory or leadership role. Experience in a laboratory or diagnostic testing environment highly preferred.