Director - Denial Recovery (Remote)

Stanford Health Care

3d • $89 - $118 • Remote

About The Position

The Director, Denial Recovery provides strategic leadership and operational oversight for multiple denials workstreams and is accountable for the timely and accurate resolution of denied and underpaid claims in accordance with current contracts, federal/state regulations, and SHC policies. This role is responsible for the performance of assigned Accounts Receivable associated with denials and/or underpayments, including prevention, recovery, and appeal strategies across hospital and physician services. The Director, Denial Recovery serves as a subject matter expert, leads complex denial operations, partners with internal and external stakeholders to address payer trends, and drives continuous improvement to optimize reimbursement and reduce avoidable denials. In addition, the Director, Denial Recovery builds and develops a high‑performing team by recruiting and onboarding talent; providing ongoing coaching, feedback, and competency-based training; and conducting performance management that aligns individual goals with department objectives. The Director, Denial Recovery establishes clear productivity expectations and standard work, sets individual and team targets, and leverages reports and dashboards to monitor timeliness, overturn rates, aged A/R, and appeal quality. The role maintains a robust quality assurance program, including routine audits and documentation standards in Epic and related systems, ensuring accuracy, compliance, and consistency; uses audit results and payer trend analyses to inform targeted education, process improvements, and workload balancing; and proactively removes barriers to sustain productivity and quality outcomes. The Director, Denial Recovery also leads and/or partners on Epic optimization and the evaluation, pilot, and implementation of AI-enabled and related technologies to enhance denial prevention, prioritization, and resolution workflows.

Requirements

• Bachelor’s degree in Business, Health Care Administration, Finance, or a related field Required.
• Ten (10) years of progressively responsible and directly related work experience in healthcare revenue cycle, with a minimum of seven (7) years of direct experience in denial management overseeing denial recovery.
• Five (5) years of leadership experience supervising teams or managing operations in denial resolution or related revenue cycle functions.
• Demonstrated experience leading Epic HB and/or PB denial workflow optimization and partnering with IS/Analytics on system enhancements, reporting, and adoption preferred Required.
• Expertise in denials management and insurance account resolution; deep knowledge of government and commercial payer requirements, reimbursement rules, and laws/regulations governing billing and collections; strong understanding of front-, middle-, and back-end Revenue Cycle workflows and their impact on denial prevention.
• Working knowledge of medical terminology, CPT-4, ICD-10, HCPCS, and modifiers, and how they drive reimbursement.
• Advanced analytics and financial acumen: knowledge of data analytics techniques and best practices; ability to independently identify issues through data analysis, interpret complex contracts and payer policies, and assess/evaluate complex financial data to drive actions.
• Strong problem-solving and decision-making skills with sound judgment, attention to detail, and thorough follow-through; ability to develop solutions to complex problems.
• Leadership and people management: ability to plan, organize, motivate, mentor, direct, and evaluate the work of others; demonstrated staff development, performance management, and change management skills; strong ability to lead initiatives, influence leaders within and outside Revenue Cycle, build cross-functional partnerships, and foster effective working relationships and consensus.
• Communication, presentation, and negotiation: excellent verbal and written communication skills; ability to draft compelling, level-appropriate communications; communicate effectively at all organizational levels in settings requiring instructing, persuading, negotiating, conflict resolution, consulting, and advising; effectively present complex issues to internal and external customers; effective negotiation skills for payer escalations.
• Performance improvement and transformation: knowledge of performance improvement methodologies; strong transformation skills and ability to drive change in a fast-paced organization.
• Organization and adaptability: ability to manage, prioritize, and multi-task; adapt to changing priorities.
• Strategic planning: ability to develop long-range business plans and strategy.
• Proficiency with Epic Hospital Billing (HB) and/or Professional Billing (PB) and ability to leverage Epic reporting preferred.
• CCRC - Cert Clin Resch Coord required Upon Hire

Nice To Haves

• Master’s degree in healthcare administration, finance, business, or related field Preferred.
• Experience in academic medical center or complex multispecialty environment preferred.

Responsibilities

• Set the enterprise denial recovery strategy and long‑range business plans/roadmaps aligned with revenue, compliance, and patient experience goals; establish governance for denials management and build consensus across stakeholders.
• Own enterprise performance outcomes for denial‑related A/R across Epic HB and PB (denial rate, overturn rate, days in A/R, net recovery, avoidable write‑offs, timely filing/appeal compliance); set targets and drive accountability.
• Lead a portfolio of transformation and performance improvement initiatives using data‑driven methods; redesign processes to prevent denials and accelerate recovery.
• Champion Epic optimization for denial workflows (work queues, edits, CARC/RARC mapping, workplans, documentation standards, reporting); define requirements and oversee build, testing, training, and adoption with TDS/Analytics.
• Evaluate, pilot, and implement AI‑enabled and automation solutions; establish governance, change management, compliance/privacy oversight, and outcome/ROI measurement.
• Direct payer relations for denial issues; lead escalations and joint operating committees; collaborate with Managed Care and Legal on contract interpretation and negotiation to resolve systemic barriers.
• Drive denial improvements across front, middle, and back Revenue Cycle by partnering with Prevention, Access, HIM, Coding, CDI, Case Management, PFS, and Ambulatory operations; implement controls and targeted education.
• Establish and maintain a robust quality assurance and compliance program for appeals and documentation; ensure accurate, complete, and audit‑ready records in Epic and related systems; uphold regulatory and payer requirements.
• Define productivity and quality standards; deploy dashboards and visual management to monitor throughput, accuracy, and escalation timeliness; proactively remove barriers to meet goals.
• Plan and manage budgets and resources for the denial recovery function; assess and evaluate complex financial data, forecast recoveries, and develop business cases/ROI for operational and technology investments; manage variances.
• Build organizational capability: recruit, develop, mentor, and evaluate leaders and staff; implement succession planning and competency‑based training focused on analytics, appeals, payer negotiation, and technology adoption.
• Develop and deliver level‑appropriate communications (policies, playbooks, executive updates, change communications, and training materials); effectively present complex issues and recommendations to internal and external audiences.
• Create, maintain, and ensure adoption of denial job aids/playbooks for denial resolution, recovery, and appeals; monitor effectiveness and continuously update based on payer policy and regulatory changes (CMS/Medicare/Medicaid).
• Monitor national guidelines and payer policy updates; ensure timely workflow adjustments and targeted staff education to maintain compliance and optimize reimbursement.
• Standardize workflows, policies, and procedures across teams; coordinate change management for new technologies, regulatory updates, and process changes.
• Manage vendors and external partners supporting denial recovery (e.g., outsourcing, technology); negotiate SLAs, track performance, and ensure alignment with organizational goals and compliance.
• Identify systemic risks, escalate appropriately, and lead cross‑functional remediation; ensure business continuity for critical denial workflows.

Benefits

• Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery. You will do this by executing against our three experience pillars, from the patient and family’s perspective: Know Me: Anticipate my needs and status to deliver effective care Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health Coordinate for Me: Own the complexity of my care through coordination
• Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
• Base Pay Scale: Generally starting at $89.01 - $117.94 per hour
• The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.
• At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow. As part of our spirit of discovery, we also leverage our deep relationships with luminary Silicon Valley companies to develop new ways to deliver preeminent patient care. Learn about our awards and significant events.

What This Job Offers

• Job Type: Full-time
• Career Level: Director