Supervisor-Denials & Appeals

Presbyterian Healthcare Services•Remote Workers New Mexico, NM

5d•$50,482 - $77,106•Remote

About The Position

Join our team and play a key role in maximizing reimbursement and improving revenue cycle performance. As the Supervisor, Denials & Appeals, you will oversee and coordinate the daily operations of the Denials & Appeals team, ensuring that all third-party and government payer denials are accurately identified, reviewed, and processed to optimize reimbursement outcomes. In this leadership role, you will direct appeal activities in accordance with Presbyterian Patient Financial Services (PFS) policies, payer contracts, and regulatory guidelines. You will partner with leadership to develop, analyze, and implement strategies that improve denial overturn rates, reduce overall denials, and enhance cash collections. Additionally, you will continuously evaluate workflows to identify opportunities for process improvement, automation, and operational efficiency. You will also contribute to root cause analysis initiatives, collaborating with operational teams to identify trends, address underlying issues, and implement sustainable solutions that prevent future denials and support organizational financial performance. This is an excellent opportunity for a results-driven leader who is passionate about process improvement, team development, and delivering exceptional revenue cycle outcomes.

Requirements

One to two years of college-level coursework required, or three years of healthcare business office experience may be substituted in lieu of college coursework.
Minimum of two years of experience in healthcare billing, collections, denial management, or revenue cycle operations required.
Working knowledge of insurance billing and reimbursement methodologies, including medical terminology, ICD-10, CPT, and HCPCS coding systems.
Demonstrated ability to communicate effectively, both verbally and in writing, with patients, payers, providers, and colleagues.
Strong organizational, interpersonal, and leadership skills, with the ability to prioritize multiple responsibilities and meet deadlines in a fast-paced environment.
Proven ability to work independently, exercise sound judgment, and effectively manage competing priorities while maintaining a high level of accuracy and customer service.
Familiarity with CMS-1500 and UB-04 claim forms, as well as 837 electronic claim submission and 835 electronic remittance processing, required.

Responsibilities

Supervise the day-to-day operations of the Denials & Appeals team, ensuring accounts are processed accurately, timely, and in accordance with established quality and performance standards.
Monitor work queues, denial inventories, system-generated reports, and quality audits to prioritize workloads, assign resources, and optimize team productivity.
Analyze denial trends and produce reporting to support operational improvements, increase denial overturn rates, and reduce overall denial volumes.
Identify, investigate, and resolve complex denial and reimbursement issues while collaborating with internal departments and external payers to achieve successful outcomes.
Ensure all departmental processes are documented and maintained in compliance with Presbyterian Healthcare Services standards, regulatory requirements, and audit expectations.
Serve as a subject matter expert and resource for denial and appeals processes, providing guidance, training, and timely communication to staff and stakeholders.
Participate in denial management workgroups and root-cause analysis initiatives to identify process improvements and support revenue cycle performance.
Lead, coach, develop, and evaluate team members, including hiring, onboarding, performance management, corrective action, and employee engagement activities.
Foster a high-performing, customer-focused team culture committed to delivering exceptional service to patients, payers, and internal stakeholders.
Maintain current knowledge of payer policies, regulations, and industry trends, and support departmental projects and continuous improvement initiatives as assigned.