Manager Payer Denials and Recovery

Responsibilities

Provides leadership and oversight for Payer Denials and Recovery operations across Piedmont Healthcare. Responsible for managing the day-to-day operations of denial management, appeals, payer escalations, recoupment defense, underpayment recovery, interest payment recovery, reimbursement reconciliations, contract compliance reviews, denial analytics, self-funded TPA payment escalations, revenue recovery special projects, and other payer accountability initiatives. This leader is responsible for protecting earned revenue, recovering underpayments, defending inappropriate payer recoupments, reducing denial losses, ensuring payer compliance with contractual and regulatory obligations, and identifying opportunities to improve reimbursement performance. The Manager collaborates with Revenue Cycle Operations, Managed Care, Revenue Integrity, Finance, Informatics, Compliance, Legal, and payer organizations to resolve complex reimbursement issues and support enterprise revenue recovery strategies. Functional areas that may report to this position include Denials Management, Appeals Operations, Payer Escalations, Recoupment Defense, Interest Recovery, Underpayment Recovery, Contract Compliance Reviews, Payment Variance Analysis, Payer Reconciliations, Denial Analytics, Revenue Recovery Special Projects, Self-Funded TPA Escalations, Regulatory Recovery Activities, and other functions as assigned.

Qualifications

Education

• Bachelor’s Degree in Business Administration, Healthcare Administration, Finance, Accounting, Health Information Management or related field Required or
• In Lieu of degree six (6) years of additional Revenue Cycle experience will be accepted in addition to the minimum experience requirement Required

Work Experience

• 5 years of Revenue Cycle experience within one or more of the following areas: Denials Management, Appeals Operations, Payer Recovery, Underpayment Recovery, Contract Compliance, Revenue Integrity, Hospital Billing and/or Follow-up, Physician Billing and/or Follow-up, Managed Care Reimbursement, Third-Party Follow-Up, or Payment Variance Analysis Required or
• In lieu of degree If no degree, a total of eleven (11) years of experience required. Required
• 3 years of experience to include leadership or supervisory/management experience. Required
• 8 years or more years of Revenue Cycle experience Preferred
• 5 years or more years of management experience Preferred
• Previous Epic Revenue Cycle experience Preferred
• Experience managing two or more of the following preferred: Denials Management, Appeals Operations, Payer Escalations, Underpayment Recovery, Recoupment Defense, Interest Recovery Programs, Contract Compliance Reviews, Payment Variance Analysis, Revenue Recovery Special Projects, Payer Audit Responses, Self-Funded TPA Dispute Resolution, ERISA Plan Payment Escalations, Managed Care Reimbursement Reviews, Denial Trending and Analytics, Regulatory Complaint Support, or Independent Dispute Resolution (IDR) Activities Preferred

Licenses and Certifications

• HFMA Certification, CRCR, RHIA, RHIT, CPC, Lean Six Sigma, or other healthcare financial certification Preferred

Business Unit : Company Name

Piedmont Healthcare Corporate

Originally posted on Himalayas