Denials & Appeals Leader, Revenue Cycle Strategy

Washington Health; Fremont (CA); On-site; USD 113,000 - 164,000; Full time

Job summary

Washington Health is seeking a strategic Manager of Billing Denials and Appeals to lead a comprehensive program that prevents, manages, and overturns payer denials while maximizing reimbursement across all payer classes.

The role partners with patient accounting, coding, CDI, utilization review, case management, and contracting teams to identify denial trends, execute root cause analysis, and drive systemic improvements in cash flow and compliance.

Qualifications

• Minimum of 5 years of progressive hospital revenue cycle experience, with at least 3 years in a denials management, appeals, or utilization review leadership role.
• Demonstrated experience managing teams and leading cross-functional improvement initiatives in a hospital or integrated health system environment.
• In-depth knowledge of payer regulations, reimbursement methodologies (DRG, APC, per diem, fee schedule), CMS guidelines, and commercial payer contract interpretation.

Responsibilities

• Establish and achieve departmental targets for denial rate reduction, appeal overturn rates, and days-to-resolution, reporting progress to revenue cycle leadership quarterly.
• Lead root cause analysis initiatives that result in measurable, sustained decreases in preventable denials across clinical, technical, and administrative categories.
• Drive financial recovery efforts by ensuring high-dollar and complex denials are prioritized, worked, and resolved within payer-defined timelines.
• Monitor team productivity and quality metrics, implementing corrective action plans when performance falls below established benchmarks.
• Deliver documented cost savings and revenue recovery results through successful audit defense and appeal outcomes.
• Set individual and team performance goals aligned with organizational revenue cycle objectives and conduct regular progress reviews.

Skills

Leadership

Payer regulations

Data analysis

Communication skills

Education

Bachelor's degree in Nursing or related field

Master's degree preferred

RN licensure or coding certification preferred

Tools

Epic

Cerner

Meditech

Kodiak

Optum360

Availity

InterQual

Milliman

Job description

Washington Health is seeking a strategic Manager of Billing Denials and Appeals to lead a comprehensive program that prevents, manages, and overturns payer denials while maximizing reimbursement across all payer classes.

The role partners with patient accounting, coding, CDI, utilization review, case management, and contracting teams to identify denial trends, execute root cause analysis, and drive systemic improvements in cash flow and compliance.