Manager Technical Denials - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

Capital Health (US)•Pike, NY

1d•Onsite

About The Position

The Manager of Technical Denials is responsible for the oversight and management of technical denial activities within the denials team scope, including authorization and notification issues, payer processing errors, and other non-clinical denial types. This role ensures consistent resolution workflows, accurate root-cause identification, and sustained denial prevention through cross-functional collaboration.

Requirements

Bachelor's degree. A High School diploma or equivalent and additional years of experience may be considered in lieu of a formal Bachelor's degree.
Four years of progressively responsible experience in hospital billing, denials management, claims resolution or related revenue cycle functions if accompanied by a Bachelor's degree.
Eight years progressively responsible experience in hospital billing, denials management, claims resolution or related revenue cycle functions if accompanied by a high school diploma or equivalent.
Strong understanding of technical denial categories (authorization, notification, payer processing, claim edits within scope)
Deep knowledge of hospital billing workflows and payer claim adjudication processes
Proven ability to perform and teach root-cause analysis and corrective action methodologies
Strong organizational and communication skills
Ability to work cross-functionally with Patient Access, UR, Billing, Coding, and Revenue Integrity
Proficient in Microsoft Office.
Working knowledge of insurance contracting principles and payer administrative policies.
Ability to provide leadership and definition to a new team.
Must be skilled in management to provide guidance as priorities change.
Must have ability to meet deadlines and attention to detail.
Must demonstrate good judgment.
Must be metric-driven and results oriented.

Nice To Haves

Demonstrated experience managing or leading teams is preferred.

Responsibilities

Oversees daily technical denial operations, ensuring timely and accurate resolution of assigned denial types
Establishes standardized research, correction, resubmission, and escalation workflows
Defines and maintains scope boundaries between denials, billing, coding, and revenue integrity functions
Reviews denial trends and root causes to identify upstream process failures
Partners with operational leaders to implement sustainable prevention strategies and process improvements
Ensures appropriate documentation and system notes are maintained in accordance with departmental standards
Collaborates with payor relations team to support communications and escalations related to recurring technical denial issues
Monitors productivity, quality, and outcomes; provides coaching and performance feedback to staff
Maintains current knowledge of payer requirements, billing rules, and denial best practices
Supports reporting and analytics efforts related to technical denial performance and prevention
Performs other duties as assigned