Supervisor-Denials & Appeals-ABQ

Location Address:9521 San Mateo NE Albuquerque, NM 87113-2237Compensation Pay Range:Minimum Offer $50,481.60 Maximum Offer $77,105.60 Now Hiring: Supervisor-Denials & Appeals-ABQSummary:Build your career strategically to maximize reimbursement outcomes. Direct appeal activities in accordance with Presbyterian PFS policies, objectives, and payer agreements and guidelines. Assist the manager with the development, analysis, and implementation of strategies to improve denial overturn rates, reduce overall denial rates, and enhance cash collections. Continuously evaluate processes to identify opportunities for streamlining and automation, maximizing efficiency and effectiveness. Support root cause analysis of issues and collaborate with operations to implement process improvements that reduce denials. Type of Opportunity: Full time Job Exempt: Yes Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Weekday Schedule Monday-Friday (United States of America)Responsibilities:The Supervisor, Denials and Appeals leads the daily operations of the Denials and Appeals team, ensuring timely and accurate resolution of accounts in alignment with Presbyterian Health Services (PHS) policies, regulatory requirements, and payer guidelines. This role focuses on optimizing denial overturn rates, reducing denial volumes, and improving cash collections through strategic oversight, process improvement, and team leadership. The supervisor collaborates with internal departments and external partners to identify root causes of denials, implement corrective actions, and drive continuous improvement while fostering a high-performing, customer-focused team environment.Key ResponsibilitiesSupervise the day-to-day operations of the Denials and Appeals team, ensuring accounts are processed in accordance with established quality and performance standards.Monitor system-generated reports, quality audits, and work queues to evaluate performance and identify opportunities for improved efficiency and effectiveness.Develop and implement strategies to improve denial overturn rates, reduce denial volumes, and enhance overall cash collections.Assist leadership in ensuring all processes are documented in accordance with PHS standards to support regulatory compliance and audit readiness.Identify, investigate, and resolve complex denial issues, ensuring coordination across Professional Billing (PB) and Hospital Billing (HB) and all impacted stakeholders.Serve as a subject matter expert and resource for internal and external inquiries, promoting clear, timely, and effective communication.Review inventory and workload trends daily/weekly to prioritize work, allocate resources, and establish team assignments.Participate in denial management workgroups and collaborate with cross-functional teams to improve operational processes and reduce denial rates.Lead team performance, including hiring, coaching, counseling, and disciplinary actions, and partner with leadership to implement corrective action plans when needed.Foster a high-performing, customer-focused team by promoting continuous learning, reviewing payer policy updates, and ensuring compliance with all regulatory and payer requirements.Perform other duties as assigned and support Patient Financial Services (PFS) projects as needed.Qualifications:One to two years of college-level coursework OR three years of healthcare business office experience in lieu of college educationMinimum of two years of experience in healthcare billing and/or collections requiredProficient knowledge of insurance billing and reimbursement methodologiesWorking knowledge of medical terminology, ICD-10, CPT, and HCPCS coding systemsFamiliarity with CMS-1500 and UB-04 claim formsExperience with 837 electronic claims processing and 835 electronic remittance processingDemonstrated ability to communicate effectively, both verbally and in writing, with customers, providers, and peersStrong organizational, interpersonal, and time management skillsAbility to work independently and effectively in a fast-paced environmentAll benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.WellnessPresbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.Why work at Presbyterian?As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.About Presbyterian Healthcare ServicesPresbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services #J-18808-Ljbffr Presbyterian System Services