Nephrology Associates of
Job Description
Job Description
Revenue Cycle Denial Manager Why NANI? NANI is the nation’s largest Nephrology practice. We have provided excellence in specialty kidney care for over 50 years. NANI’s nephrology practices are primarily operated in northern Illinois and throughout northern and central Indiana, with additional locations in New Jersey. NANI’s scope of care and services includes difficult-to-control hypertension, kidney disease, kidney injury, kidney transplant, and related services, as well as groundbreaking and lifesaving clinical research and consulting services. Join Our Team! Job Title: Revenue Cycle Denial Manager Location: In-office Reports To: Director of Revenue Cycle FLSA Status: Exempt Position Summary: The Revenue Cycle Denial Manager – Is responsible for leading and overseeing all denial management activities within the revenue cycle. This role will develop and implement strategies to reduce claim denials, improve collections, and ensure compliance with payer requirements. The ideal candidate will have strong leadership skills, extensive knowledge of medical billing and coding practices, and a results-driven approach to denial resolution and revenue recovery. Key Responsibilities: • Denial Oversight & Analysis: o Analyze denial trends and root causes identify patterns and systemic issues. o Monitor daily, weekly, and monthly denial reports and dashboards. o Ensure timely follow-up and resolution of denied or underpaid claims. o Collaborate with payers to understand denial reasons and policy changes. • Process Improvement: o Develop denial prevention strategies through improved documentation, coding, and billing practices. o Implement workflows and standard operating procedures for denial management. o Provide feedback and training to staff to reduce preventable denials. • Team Leadership: o Supervise denial management and A/R follow-up teams. o Set performance goals, KPIs, and ensure accountability for denial resolution timelines. o Conduct regular meetings to review performance metrics and escalate unresolved issues. • Collaboration & Communication: o Work cross-functionally with coding, billing, credentialing, clinical, and registration teams. o Serve as the primary point of contact for payer relations related to denial issues. o Participate in payer meetings to discuss trends, appeals, and resolution processes. • Appeals & Escalations: o Oversee appeal preparation, submission, and tracking processes. o Ensure all appeals are documented and follow payer-specific guidelines. o Escalate chronic denial issues to leadership and/or legal as appropriate. • Compliance & Documentation: o Ensure denial management processes adhere to HIPAA and payer regulations. o Maintain up-to-date payer policies, denial codes, and appeals processes. o Prepare reports for senior management on denial metrics and financial impact. Qualifications: • Bachelor’s degree in health administration, Business, or related field (preferred). • 5+ years of experience in medical billing and revenue cycle operations, with at least 2 years in a leadership or supervisory role. • In-depth knowledge of denial codes, appeals processes, and payer billing guidelines. • Familiarity with CPT, ICD-10, and HCPCS coding systems. • Proficiency in EMR/EHR and billing systems (e.g., NextGen, Epic, Athena, etc.). • Strong analytical, organizational, and communication skills. • Certification in Medical Billing or Coding (e.g., CPB, CPC, or CMRS) is a plus. Key Skills: • Denial root cause analysis • A/R management and recovery • Revenue cycle optimization • Payer relations and contract knowledge • Staff development and leadership • Strategic problem solving
Job Description
Revenue Cycle Denial Manager Why NANI? NANI is the nation’s largest Nephrology practice. We have provided excellence in specialty kidney care for over 50 years. NANI’s nephrology practices are primarily operated in northern Illinois and throughout northern and central Indiana, with additional locations in New Jersey. NANI’s scope of care and services includes difficult-to-control hypertension, kidney disease, kidney injury, kidney transplant, and related services, as well as groundbreaking and lifesaving clinical research and consulting services. Join Our Team! Job Title: Revenue Cycle Denial Manager Location: In-office Reports To: Director of Revenue Cycle FLSA Status: Exempt Position Summary: The Revenue Cycle Denial Manager – Is responsible for leading and overseeing all denial management activities within the revenue cycle. This role will develop and implement strategies to reduce claim denials, improve collections, and ensure compliance with payer requirements. The ideal candidate will have strong leadership skills, extensive knowledge of medical billing and coding practices, and a results-driven approach to denial resolution and revenue recovery. Key Responsibilities: • Denial Oversight & Analysis: o Analyze denial trends and root causes identify patterns and systemic issues. o Monitor daily, weekly, and monthly denial reports and dashboards. o Ensure timely follow-up and resolution of denied or underpaid claims. o Collaborate with payers to understand denial reasons and policy changes. • Process Improvement: o Develop denial prevention strategies through improved documentation, coding, and billing practices. o Implement workflows and standard operating procedures for denial management. o Provide feedback and training to staff to reduce preventable denials. • Team Leadership: o Supervise denial management and A/R follow-up teams. o Set performance goals, KPIs, and ensure accountability for denial resolution timelines. o Conduct regular meetings to review performance metrics and escalate unresolved issues. • Collaboration & Communication: o Work cross-functionally with coding, billing, credentialing, clinical, and registration teams. o Serve as the primary point of contact for payer relations related to denial issues. o Participate in payer meetings to discuss trends, appeals, and resolution processes. • Appeals & Escalations: o Oversee appeal preparation, submission, and tracking processes. o Ensure all appeals are documented and follow payer-specific guidelines. o Escalate chronic denial issues to leadership and/or legal as appropriate. • Compliance & Documentation: o Ensure denial management processes adhere to HIPAA and payer regulations. o Maintain up-to-date payer policies, denial codes, and appeals processes. o Prepare reports for senior management on denial metrics and financial impact. Qualifications: • Bachelor’s degree in health administration, Business, or related field (preferred). • 5+ years of experience in medical billing and revenue cycle operations, with at least 2 years in a leadership or supervisory role. • In-depth knowledge of denial codes, appeals processes, and payer billing guidelines. • Familiarity with CPT, ICD-10, and HCPCS coding systems. • Proficiency in EMR/EHR and billing systems (e.g., NextGen, Epic, Athena, etc.). • Strong analytical, organizational, and communication skills. • Certification in Medical Billing or Coding (e.g., CPB, CPC, or CMRS) is a plus. Key Skills: • Denial root cause analysis • A/R management and recovery • Revenue cycle optimization • Payer relations and contract knowledge • Staff development and leadership • Strategic problem solving