Revenue Cycle Lead: Denials, Appeals & Optimization

Necco; Cincinnati (OH); On-site; USD 90,000 - 120,000; Full time

Job summary

Necco is a social enterprise focused on transforming child welfare and seeks a Senior Revenue Cycle Specialist to lead per diem and fee-for-service billing, denial management, and accounts receivable workflows. This role partners with the Revenue Cycle Manager to improve reimbursement outcomes and sustain financial health.

You will provide training, set standards, analyze data, and guide the team without direct supervision, ensuring compliance and accurate billing.

Qualifications

• Minimum of five (5) years of experience in healthcare revenue cycle operations, with demonstrated expertise in billing, accounts receivable follow-up, denial management, and reimbursement recovery
• Experience with Medicaid, Managed Care Organizations (MCOs), and governmental billing; behavioral health and per diem billing experience preferred
• Experience with EHR and clearinghouse systems
• Strong analytical, problem-solving, communication, and leadership skills, including experience training or mentoring team members
• Credentialing and enrollment experience and experience leading process improvement projects preferred
• Successful completion of all required criminal background checks; Valid driver's license and state minimum auto insurance

Responsibilities

• Act as lead resource and subject matter expert for Revenue Cycle operations
• Assist in establishing department standards, workflows, and best practices
• Provide guidance, training, onboarding, and cross-training support to Revenue Cycle team members
• Use data, trends, and root cause analysis to identify operational risks and reimbursement barriers and support measurable improvement
• Communicate effectively with team members, leadership, payers, and operational partners to resolve issues and support collaboration
• Assist Revenue Cycle Manager with special projects and strategic initiatives
• Serve as subject matter expert for per diem billing processes
• Monitor billing timeliness and accuracy and identify and resolve billing issues impacting reimbursement
• Collaborate with operational teams to resolve authorization, census, and invoicing concerns
• Develop standardized billing procedures and training materials
• Serve as operational lead for fee-for-service (FFS) billing activities
• Review billing workflows and identify opportunities to improve accuracy and reimbursement
• Monitor claim submission performance
• Provide support for complex billing issues and claim corrections
• Perform and oversee charge reconciliation processes
• Validate that services rendered are accurately reflected in billing systems and identify missing charges or revenue leakage
• Collaborate with clinical and operational teams to resolve discrepancies
• Recommend process improvements to reduce missed billing opportunities
• Lead investigation and resolution of complex denials
• Analyze denial trends and develop appeal strategies
• Prepare and submit high-value appeals
• Monitor appeal outcomes and identify opportunities for improvement
• Serve as escalation point for reimbursement disputes
• Monitor aging accounts receivable and support reduction of aged balances
• Assist team members with complex reimbursement issues
• Review productivity and reimbursement trends
• Escalate payer issues as needed
• Serve as Revenue Cycle liaison for credentialing-related reimbursement issues
• Monitor credentialing impacts on billing and reimbursement and support escalation of enrollment and payer participation concerns
• Assist with development of credentialing workflows and tracking processes
• Provide backup support during staffing gaps
• Review coding-related billing trends and denial patterns and identify opportunities for coding education and documentation improvement
• Collaborate with providers, operations, and leadership to address recurring coding concerns
• Assist with implementation of coding-related billing edits and workflow improvements
• Stay informed of coding and payer requirements affecting reimbursement
• Perform quality reviews of billing, payment posting, appeals, and accounts receivable follow-up activities with a focus on accuracy, accountability, and attention to detail
• Monitor compliance with organizational policies and payer requirements
• Assist with auditing and quality improvement initiatives
• Lead workflow standardization efforts and develop and maintain department job aids and process documentation
• Assist with KPI development and monitoring and use results to identify barriers and support measurable outcomes
• Recommend automation and efficiency opportunities
• Participate in EHR and system improvement initiatives
• Supports timely and accurate billing, claim submission, payment posting review, and accounts receivable follow-up activities
• Contributes to reduced denials, improved appeal outcomes, decreased aged receivables, and increased reimbursement recovery
• Maintains consistent workflow documentation, job aids, and training resources that support team efficiency and cross-training
• Demonstrates measurable progress toward departmental goals, quality standards, process improvements, and financial sustainability
• Models Necco’s mission, vision, and values through professionalism, ownership, collaboration, and measurable results
• Maintains a solution-focused approach when working with internal teams, external partners, and cross-functional stakeholders
• Protects confidentiality and supports compliance with organizational policies, payer requirements, and regulatory expectations
• Contributes to a positive team culture by demonstrating accountability, respect, continuous learning, and commitment to building families

Skills

Analytical skills

Problem-solving

Communication

Leadership

Training/mentoring

Attention to detail

Education

CPC, CPB, CRCR or similar certification

Tools

EHR systems

Clearinghouse systems

Job description

Necco is a social enterprise focused on transforming child welfare and seeks a Senior Revenue Cycle Specialist to lead per diem and fee-for-service billing, denial management, and accounts receivable workflows. This role partners with the Revenue Cycle Manager to improve reimbursement outcomes and sustain financial health.

You will provide training, set standards, analyze data, and guide the team without direct supervision, ensuring compliance and accurate billing.