Manager, Denials Operations

Job Description

Job Description

Description:

The Manager of Denials Operations is responsible for day-to-day supervisory oversight and operational execution of technical and coding denial management functions within the Revenue Cycle department. Reporting to the Director of Denials Management, this role leads a team of denial specialists and coordinators focused on resolving technical and coding-related claim denials across all payer types, facilities, and service lines.

This is a hands-on management role that requires equal command of billing operations and coding fundamentals. The Manager keeps denial queues moving, ensures appeal deadlines are met, drives root cause analysis back to the source, and develops staff to perform at a consistently high level. While the Director carries strategic accountability for the full denial program, the Manager is the operational engine who makes it run.

Duties and Responsibilities

Daily Operations and Queue Management

• Knows, understands, incorporates, and demonstrates the Healthrise Core Values in all interactions with team members, clients, and stakeholders.

• Manage daily denial work queues for technical and coding denial categories, ensuring cases are assigned, prioritized by financial impact and deadline risk, and resolved within payer-required timelines.

• Monitor team workload, capacity, and throughput on a daily and weekly basis; adjust case assignments and staffing allocation to prevent missed filing deadlines.

• Serve as the first-line escalation point for complex technical and coding denial cases that require manager-level review, payer contact, or cross-functional coordination.

• Track and report weekly team performance to the Director including denial volumes, appeal activity, resolution rates, write-off risk, and aging by payer, denial code, and category.

• Identify systemic denial patterns or payer behavior trends in the queue and escalate to the Director with root cause analysis and recommended corrective actions.

Technical Denial Management

• Oversee resolution of technical denials including timely filing, prior authorization, eligibility, coordination of benefits, duplicate billing, medical records requests, and credentialing-related claim rejections.

• Review and approve appeal submissions for high-dollar or complex technical denials prior to filing, ensuring accuracy, completeness, and appropriate supporting documentation.

• Partner with Patient Access, Provider Enrollment, Utilization Management, and Billing to trace technical denial root causes back to the point of origin and drive sustainable upstream corrections.

• Maintain payer-specific technical denial resolution guides and timely filing tracking tools, ensuring the team has current reference materials for each major payer and plan type.

• Coordinate medical records retrieval for technical denial appeals and audits, ensuring records are complete, accurate, and submitted within required timeframes.

Cross-Functional Root Cause and Prevention

• Conduct structured root cause analyses on high-volume technical and coding denial categories; present findings and corrective action plans to the Director with supporting denial data.

• Participate in cross-functional process improvement workgroups with Patient Access, Billing, Provider Enrollment, HIM, CDI, Coding, and Compliance to address upstream denial drivers.

• Contribute to the development and delivery of denial prevention education for billing, coding, and access staff based on denial trend data and root cause findings.

People Leadership and Development

• Supervise, coach, and develop a team of denial specialists and coordinators across technical and coding denial functions; conduct regular one-on-ones, performance reviews, and development conversations.

• Onboard new denial staff, including training on denial workflows, billing and coding fundamentals, payer-specific requirements, and team productivity expectations.

• Maintain individual productivity and quality scorecards for each team member; hold staff accountable to performance standards through consistent feedback and documented corrective action when needed.

• Identify high-potential staff and partner with the Director on development planning and succession within the denial operations team.

• Performs other duties as assigned.

Qualifications

Required

• Bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field; or an equivalent combination of education and experience.

• Minimum 5 years of experience in healthcare revenue cycle with a focus on denials management, claims resolution, or billing operations, including at least 2 years in a lead, supervisory, or management role.

• Demonstrated experience managing technical and coding denial queues across Medicare, Medicaid, Medicare Advantage, and commercial payer types.

• Working knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding systems and their relationship to claim adjudication, reimbursement, and coding-related denial rationale.

• Solid understanding of Medicare and Medicaid billing regulations, managed care authorization requirements, payer contract terms, and timely filing rules across major payer types.

• Familiarity with NCCI edits, modifier usage, DRG methodology, and common coding denial patterns for inpatient and outpatient service lines.

• Proficiency with major EHR and revenue cycle platforms (Epic, Cerner/Oracle Health, Meditech, or equivalent) and denial management workflow tools.

• Completion of regulatory/mandatory certifications as required.

• Willingness and ability to travel to client or organizational sites as needed.

Preferred

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).

• Certified Revenue Cycle Professional (CRCP) or Certified Revenue Cycle Representative (CRCR).

• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT).

• Experience supporting post-payment audit ADR workflows for RAC, MAC, or UPIC reviews.

• Experience in a multi-facility health system or revenue cycle consulting environment managing denial operations across multiple sites or client engagements.

• Familiarity with denial management analytics tools and reporting platforms such as Tableau, Power BI, or SQL.

Physical Demands and Work Environment

• Primarily office or remote-based environment; hybrid schedule may be available based on organizational policy.

• Prolonged periods of sitting at a desk and working on a computer.

• Ability to communicate clearly in person, by phone, and via video conference with billing, coding, clinical, and payer stakeholders.

• Occasional extended hours may be necessary during high-volume denial periods, audit response windows, or to meet appeal filing deadlines.