Denials Management Director

adventhealth; Biñan; On-site; PHP 6,906,000 - 12,845,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off

403-B Retirement Plan

4 Weeks Paid Parental Leave

Career Development

Whole Person Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth seeks a senior leader to direct denial management across our system. You will shape policies, monitor performance metrics, and guide teams toward sustainable improvement in denials and appeals.

Lead payer relationships, ensure regulatory compliance, and partner with IT/analytics to optimize reporting and systems involved in denial management.

Qualifications

• Bachelor's degree required; master's preferred.
• 5+ years leading healthcare revenue cycle operations.
• 8+ years in healthcare receivables or related finance roles preferred.
• Strong knowledge of CPT/HCPCS/ICD coding and payer policies.
• Experience with denial management and appeals processes.

Responsibilities

• Provide strategic leadership for denial management across the system.
• Develop policies and performance standards for denial investigations.
• Oversee denial trend analysis and implement prevention strategies.
• Manage payer relationships and escalate complex denial issues.
• Ensure regulatory compliance and accreditation standards.

Skills

Revenue cycle knowledge

Payer policies

Leadership

Data analysis

Executive communication

Microsoft Office

Epic EHR

Cross-functional collaboration

Healthcare compliance

Process improvement

Denial management tools

Education

Bachelor's degree

Master's degree

Tools

Epic EHR system

Microsoft Suite

Analytics tools

Job description

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

2600 LUCIEN WAY

City:

MAITLAND

State:

Florida

Postal Code:

32751

Job Description:

• Provides strategic leadership for denial management operations across the system
• Develops and implements policies, procedures, and performance standards for denial investigation and appeals
• Oversees denial trend analysis and implements prevention strategies
• Manages payer relationships and escalates complex denial issues as appropriate
• Ensures compliance with all regulatory requirements and accreditation standards
• Develops and monitors key performance indicators for denial management
• Leads, mentors, and develops denial management staff across multiple teams
• Collaborates with revenue cycle leadership on strategic initiatives and process improvements
• Prepares and presents reports on denial performance to executive leadership
• Manages departmental budget and resource allocation
• Partners with IT and analytics teams to optimize denial management systems and reporting
• Performs other duties as assigned

Knowledge, Skills, and Abilities:

• Comprehensive understanding of revenue cycle processes including charge capture, billing, and reimbursement [Required]
• Extensive knowledge of CPT, HCPCS, ICD coding systems, and billing regulations for government and commercial payers [Required]
• Expert knowledge of payer policies, denial processes, and appeal strategies [Required]
• Strong leadership skills with ability to develop and manage high-performing teams [Required]
• Excellent analytical skills with ability to interpret complex data and drive strategic decisions [Required]
• Strong written and verbal communication skills with ability to present to executive leadership [Required]
• Proficiency in Microsoft Suite applications and healthcare information systems [Required]
• Ability to build collaborative relationships across organizational boundaries [Required]
• Knowledge of healthcare compliance and regulatory requirements [Required]
• Proficiency with Epic EHR system [Preferred]
• Experience with Six Sigma, Lean, or other process improvement methodologies [Preferred]
• Experience with payer contract negotiations related to denials [Preferred]
• Experience with denial management technology platforms and analytics tools [Preferred]

Education:

• Bachelor's [Required]
• Master's [Preferred]

Field of Study:

• in finance, accounting or healthcare administrative field

Work Experience:

• 5+ years of progressive leadership experience in healthcare revenue cycle operations, patient financial services, patient access management, or related healthcare financial operations [Required]
• 8+ years of progressive leadership experience in healthcare receivables, patient financial services, or revenue cycle operations within a complex healthcare environment. [Preferred]

Additional Information:

• An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:
• Bachelor's Degree AND 5+ years of related work experience [Required] OR
• Associate's Degree AND 7+ years of related work experience [Required] OR
• 9+ years of related work experience [Required]

Licenses and Certifications:

• Healthcare Financial Management Association (HFMA) [Preferred]
• Certified Revenue Cycle Rep (CRCR) [Preferred]

Physical Requirements:

Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

$110,702.15 - $205,911.28

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.