Supervisor, Clinical Denials & Appeals
About The Position
The Supervisor, Clinical Denials & Appeals coordinates and directs the daily activities of Clinical Appeals Specialists responsible for appeals on denied claims for ECU Health System. The role manages denial inventory and follow-up, distributes work, monitors productivity, and supports timely and accurate account resolution, with an emphasis on collaborative denial prevention and improving health system reimbursement. The supervisor reviews and approves contractual, administrative, and legally unbillable adjustments within the applicable approval threshold and in accordance with policy. The position stays current on third-party payer agreements and government regulations, represents the area in payer escalation and relationship meetings, and serves as a liaison for Managed Care reimbursement resolution. This role supervises staff, including RNs, and supports hiring, onboarding, training, development, scheduling, performance evaluations, and time and attendance. It reviews and communicates payer and governmental bulletins, responds to management requests, and follows policies and procedures, including HIPAA requirements for protecting PHI. The position is remote and based out of Greenville, North Carolina, with a Monday–Friday day shift schedule.
Requirements
- Bachelor’s degree or higher is required.
- ADN degree is required; a BSN degree may substitute for an ADN degree.
- Two years of experience beyond four years may substitute for the associate degree.
- RN licensure is required.
- Three to four years of experience in insurance or denials is required.
Responsibilities
- Coordinate and direct the daily activities of Clinical Appeals Specialists handling denied-claim appeals.
- Ensure departmental and health system policies and procedures are followed when resolving incoming denial inventory, supporting timely follow-up and denial prevention.
- Review work queue inventory and distribute workload appropriately.
- Evaluate and ensure timely follow-up on accounts by Denials Specialists; track and review time trackers and productivity reports, address workflow gaps, and identify efficiency opportunities.
- Review and approve adjustment requests within the supervisor’s approval threshold, ensuring accuracy and adequate supporting documentation and compliance with established policies.
- Assist with screening, interviewing, and hiring applicants; support onboarding, training, and staff development.
- Monitor staff performance, conduct performance evaluations, review schedules, and approve time and attendance to maintain appropriate staffing levels.
- Stay current on third-party payer contractual agreements and represent the area in payer escalation and relationship meetings.
- Serve as a liaison for Managed Care reimbursement resolution.
- Review, analyze, and communicate payer and governmental communications and bulletins with the manager and denials team.
- Stay current on federal, state, and local regulations related to claims reimbursement and denials.
- Supervise RNs.
- Protect PHI and adhere to applicable policies and procedures, including HIPAA; interact tactfully and courteously with staff, patients, and payers.
- Promote a positive image, support management goals and objectives, and handle inquiries and complaints promptly, discreetly, and effectively.
- Respond to special requests from management in a timely and accurate manner and perform other related responsibilities as requested.
Benefits
- Great Benefits (specific benefits are not listed).
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Manager
