Manager, Clinical Denials & Appeals — Lead Team

AdventHealth; Florida; On-site; USD 86,000 - 159,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Paid time off from day one

403-B retirement plan

Parental leave

Career development

Well-being resources

Mental health resources

Pet benefits

Job summary

AdventHealth in Altamonte Springs, Florida, seeks a seasoned leader to manage the clinical denials management team. You will guide staff, monitor performance, and oversee appeals to ensure accurate, timely denial resolution while aligning with regulatory requirements.

The role requires RN with BSN, strong coding knowledge, and experience with utilization management. This position offers day shifts, full-time hours, and opportunities for professional growth within a faith-based healthcare system.

Qualifications

• Strong knowledge of clinical documentation, medical terminology, and disease processes.
• CPT/HCPCS/ICD coding systems and clinical billing requirements.
• Knowledge of payer policies, regulations, and clinical denial processes for government and commercial payers.
• Understanding of utilization review criteria including MCG and InterQual.
• Demonstrated leadership and staff development abilities.
• Strong analytical skills to interpret data and identify trends.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Suite and healthcare information systems.
• Ability to build collaborative relationships across departments.
• Epic EHR familiarity (preferred).
• Process improvement methodologies experience (preferred).

Responsibilities

• Manages daily operations of the clinical denials management team.
• Supervises, coaches, and develops clinical denial management specialists.
• Monitors team performance against established metrics and productivity standards.
• Reviews and approves clinical appeals for accuracy and quality.
• Analyzes clinical denial trends and develops remediation strategies.
• Collaborates with clinical leadership, physicians, and utilization management on denial prevention.
• Coordinates with payers on complex clinical denial issues and escalations.
• Ensures compliance with all regulatory requirements and policies.
• Prepares and presents reports on clinical denial performance.
• Participates in hiring, training, and performance management processes.
• Identifies opportunities for process improvement and implements solutions.
• Performs other duties as assigned.

Skills

Clinical documentation

Medical terminology

CPT/HCPCS/ICD coding

Payer policies

Utilization review criteria

Leadership

Data analysis

Communication

Microsoft Suite/IT systems

Epic EHR (preferred)

Education

RN with BSN

Master's degree (preferred)

Tools

Epic EHR

Job description

AdventHealth in Altamonte Springs, Florida, seeks a seasoned leader to manage the clinical denials management team. You will guide staff, monitor performance, and oversee appeals to ensure accurate, timely denial resolution while aligning with regulatory requirements.

The role requires RN with BSN, strong coding knowledge, and experience with utilization management. This position offers day shifts, full-time hours, and opportunities for professional growth within a faith-based healthcare system.