Manager, Revenue Cycle Management – Denial and Appeals

The Manager, Revenue Cycle Management – Denial and Appeals is responsible for leading and supervising denial management operations, including appeals and follow-up functions. This position ensures team performance meets or exceeds internal and client KPIs while supporting the creation and execution of training materials, process improvements, and cross-functional collaboration. The Manager will monitor staff performance, ensure effective onboarding, and provide strategic insights to reduce denials and improve overturn rates.

Duties and Responsibilities

• Supervise and mentor denial management and appeals teams, ensuring high performance and productivity
• Interview, hire, onboard, and train new staff; conduct performance reviews and coach for development
• Develop and maintain quality control programs and performance evaluation processes
• Lead day-to-day operations of denial management and appeals, including planning, organizing, and performance tracking
• Analyze denial trends and overturn rates to provide data-driven recommendations for process improvements
• Collaborate with the Director and cross-functional teams to align workflows and resolve complex issues
• Ensure timely and compliant responses to payer denials and appeals
• Create internal and client-facing training resources, process overviews, and visual documentation using tools like Visio, Canva, Figma, and Lucid
• Conduct regular training sessions and process walkthroughs for internal teams and clients
• Manage third-party vendor relationships supporting denial and utilization management services
• Monitor compliance with internal policies, payer guidelines, and HIPAA regulations
• Maintain accurate reporting, documentation, and communication for both internal and external stakeholders

Skills and Competencies

• Strong leadership and team management skills
• In-depth understanding of denial and appeal processes within RCM
• Excellent written and verbal communication skills with the ability to simplify complex topics
• Skilled in creating visual aids, SOPs, and training content using PowerPoint, Canva, Lucid, or similar tools
• Highly organized with the ability to manage multiple priorities simultaneously
• Analytical and detail-oriented with a focus on performance improvement
• Customer-focused mindset with proven client-facing communication skills
• Proficient in Microsoft Office Suite and CRM or denial management software

Education and Experience

Education:

• Bachelor’s degree preferred; equivalent experience (5–7 years) in lieu of degree accepted

Experience:

• 5+ years of experience in revenue cycle management with a focus on denials and appeals
• Experience in diagnostic laboratory or healthcare setting preferred
• Experience managing and training teams in a high-volume, fast-paced environment
• Familiarity with HIPAA and healthcare compliance standards

Physical Demands and Work Environment

• Frequently required to sit, talk, and use standard office equipment
• Occasionally required to lift materials or travel for meetings or training

EEO Statement