[Hiring] Director of Denial Management & Follow-Up @MedSrv

Role Description

The Director of Denial Management & Follow-Up is a senior leadership role responsible for overseeing the strategic direction, operational execution, and performance optimization of denial management and accounts receivable follow-up functions. This position is instrumental in driving revenue integrity, reducing avoidable denials, and ensuring timely and accurate reimbursement from payers.

Key Responsibilities

• Leadership & Strategy:
  • Develop and execute initiatives to reduce denial rates, improve claim resolution timelines, and maximize reimbursement.
  • Collaborate with clinical, coding, billing, and compliance teams to ensure accurate documentation and clean claim submission.
  • Lead the response to payer audits and appeals, ensuring timely, compliant, and effective resolution.
  • Serve as a key liaison with payer representatives to resolve systemic issues and negotiate favorable outcomes.
  • Establish and monitor performance metrics, including denial trends, days in AR, cash collections, and net revenue impact.
• Process Improvement & Compliance:
  • Ensure compliance with federal, state, and payer-specific billing and reimbursement regulations.
  • Drive continuous improvement through process redesign, automation, and adoption of advanced analytics tools.
  • Collaborate with compliance and audit teams to ensure adherence to HIPAA and other regulatory standards.
• Team Leadership & Development:
  • Recruit, mentor, and develop high-performing teams, fostering a culture of accountability, collaboration, and excellence.
  • Supervise AR managers and staff; provide coaching, training, and performance evaluations.
  • Foster a culture of accountability, collaboration, and professional growth.

Qualifications

• Bachelor’s degree in healthcare administration, Business Administration, Finance, or a related field is required or job-related experience.
• Equivalent combination of education and experience may be considered.

Requirements

• Knowledge of Medicare, Medicaid, and commercial payer policies and reimbursement structures.
• Strong analytical and problem-solving skills.
• Excellent communication and leadership abilities.
• Proficiency in data analysis and reporting tools.