Strategic Manager, Denials & Appeals

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

Job summary

Washington Health is seeking a Manager of Billing Denials and Appeals to lead a comprehensive strategy to prevent, manage, and overturn payer denials while maximizing reimbursement across payer classes. This cross-functional role collaborates with patient accounting, coding, CDI, utilization review, and managed care contracting teams to identify denial trends and drive process improvements.

The role demands deep knowledge of payer regulations, reimbursement methodologies, and audit processes,

Qualifications

• Bachelor’s degree in Nursing, Health Information Management, Healthcare Administration, or closely related field required.
• Master’s degree (MHA, MBA, MSN, or equivalent) strongly preferred.
• RN licensure or coding certification (e.g., CCS, CPC) highly preferred.

Responsibilities

• Establish and achieve departmental targets for denial rate reduction, appeal overturn rates, and days-to-resolution, reporting progress 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 and resolved within payer-defined timelines.
• Monitor team productivity and quality metrics, implementing corrective action plans when performance falls below benchmarks.
• Deliver documented cost savings and revenue recovery results through successful audit defense and appeal outcomes.
• Coordinate denial prevention efforts across coding, HIM, CDI, utilization review, case management, and billing teams.

Skills

Payer regulations

Revenue cycle

Team leadership

Process improvement

Data analysis

Education

Bachelor’s degree in Nursing, Health Information Management, Healthcare Administration

Master’s degree (MHA, MBA, MSN, or equivalent)

RN licensure or coding certification (CCS, CPC)

Tools

Epic

Cerner

Meditech

Kodiak

Optum360

Availity

Job description

Washington Health is seeking a Manager of Billing Denials and Appeals to lead a comprehensive strategy to prevent, manage, and overturn payer denials while maximizing reimbursement across payer classes. This cross-functional role collaborates with patient accounting, coding, CDI, utilization review, and managed care contracting teams to identify denial trends and drive process improvements.

The role demands deep knowledge of payer regulations, reimbursement methodologies, and audit processes,