Manager, Denials Support

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

The Manager, Denials Support is responsible for overseeing the development, implementation, and maintenance of denial management processes and quality assurance initiatives. This role ensures that the CorroHealth’s Denials Management operations adhere to industry standards and internal best practices. The ideal candidate will have a strong background in denials management, process improvement, and quality management.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

• Develop, maintain, and update Denials Management processes and documentation to ensure accuracy, clarity, and effectiveness.
• Establish and oversee quality assurance frameworks to reduce error trends and improve staff efficiency.
• Conduct root cause analyses on accounts, identifying error trends and implementing corrective actions.
• Collaborate with Denials Management operational teams to ensure proper appeals submission (timeliness and method) while adhering to payer requirements.
• Implement best practices for document management, version control, and accessibility related to denials management.
• Design and facilitate training programs for staff on account processing, denials management, and quality standards.
• Monitor and analyze key performance indicators (KPIs) related to denials and revenue recovery efforts.
• Lead process improvement initiatives focused on enhancing efficiency and account processing accuracy.
• Provide guidance and mentorship to team members to foster a culture of continuous improvement and accountability.

Qualifications:

• Bachelor’s degree in healthcare administration, Business Administration, Revenue Cycle Management, or a related field (Master’s degree preferred).
• Minimum of 5 years of experience in Denials Management, revenue cycle operations, or quality assurance roles.
• Strong knowledge of healthcare billing, coding (ICD-10, CPT), and insurance reimbursement processes.
• Experience with quality management systems (QMS), process improvement methodologies (Lean, Six Sigma), and compliance standards.
• Excellent written and verbal communication skills, with attention to detail.
• Proficiency in claims processing systems, EHR/EMR software, and data analysis tools.
• Strong leadership and stakeholder management skills.
• Ability to work collaboratively across multiple departments and influence change.

Preferred Qualifications:

• Certification in Healthcare Revenue Cycle Management (e.g., CRCR, CPC, CHAM) is a plus.
• Experience in hospital or medical practice revenue cycle management.
• Familiarity with digital transformation and automation tools for Denials Management and quality assurance.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.