Director of Denials Management

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.