Manager, Appeals & Variance Management

Catholic Health•Melville, NY

About The Position

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! The Manager of Appeals oversees the end-to-end management of payer denials, variances, and appeal activities, with a strong focus on coding-related denials and payer contract compliance. This position ensures timely, accurate resolution of denied or underpaid claims, identifies root causes and trends, and collaborates with coding, contracting, and compliance teams to drive process improvements and reduce avoidable denials.

Requirements

Bachelor’s degree in Health Information Management, Healthcare Administration, Business, or related field required.
Minimum 5 years of progressive experience in hospital or physician revenue cycle management, including appeals and denials.
Minimum 2 years in a supervisory or managerial role.
Strong knowledge of payer contracts, reimbursement methodologies (DRG, APC, fee schedule, etc.), and coding/billing regulations.
In-depth understanding of ICD-10-CM/PCS, CPT, HCPCS, and modifier usage.
Familiarity with payer appeal regulations and timelines.
Strong analytical, communication, and negotiation skills.
Ability to collaborate effectively with clinical, financial, and administrative leaders.
Proficient in Excel, data visualization, and denial analytics tools.

Nice To Haves

RHIA, RHIT, CCS, or CPC credential strongly preferred.
Experience with Epic, Cerner, or equivalent EHR and contract management systems preferred.

Responsibilities

Oversee daily operations of the appeals team responsible for clinical, technical, and coding-related denials.
Ensure timely submission of first- and second-level appeals according to payer-specific deadlines and contract terms.
Review and approve complex or high-dollar appeal letters, ensuring clinical and coding accuracy.
Maintain standard appeal templates and ensure consistent, compliant appeal language across payers.
Responsible for communicating denial trends and collaborating with physicians for clinical appeals when necessary.
Monitor and manage contractual variances and underpayments to ensure payers are reimbursing in alignment with negotiated terms.
Partner with Payer Contracting to interpret reimbursement methodologies and address recurring underpayment issues.
Develop and maintain variance tracking tools and key performance metrics for payer performance.
Escalate systemic payer noncompliance and recommend action plans or contract amendments as needed.
Collaborate with the Coding and CDI teams to review documentation and coding issues contributing to denials.
Analyze denial data to identify patterns related to ICD-10, CPT, or modifier usage.
Partner with Coding Education and Compliance to ensure proper coding and clinical validation processes.
Participate in payer audits and defend coding accuracy as needed.
Track and report denial and variance trends to leadership with actionable insights.
Monitor aging, appeal success rates, and recovery performance.
Lead root cause analysis for recurring denials and collaborate with departments to implement corrective actions.
Present payer performance metrics and denial trends in monthly Revenue Cycle meetings.
Supervise appeal specialists and analysts; provide training, coaching, and performance evaluations.
Establish productivity, quality, and turnaround time benchmarks.
Foster a culture of accountability, accuracy, and continuous improvement.