Revenue Recovery & Resolutions Strategy Manager

Description

The Manager partners with Financial Reconciliation, Billing Operations, Payer Relations, Revenue Systems Strategy & Business Optimization, Patient Experience, Resupply, IT, and executive leadership to support enterprise revenue performance objectives.

The Manager partners with Financial Reconciliation, Billing Operations, Payer Relations, Revenue Systems Strategy & Business Optimization, Patient Experience, Resupply, IT, and executive leadership to support enterprise revenue performance objectives.

W/C Revenue Recovery & Resolution SME;
Team Lead, Revenue Recovery & Resolution;
Denial Strategy & Recovery Specialist;
Complex Revenue Recovery Specialist;
Patient Revenue Recovery Specialist

• Revenue Recovery Strategy:
  Develops and executes recovery strategies that improve collections, reduce aging, resolve denials, and maximize recoverable revenue.
• Financial & Operational Acumen:
  Analyzes reimbursement trends, financial performance, payer behavior, and operational barriers to identify risks and prioritize recovery opportunities.
• Leadership & Accountability:
  Leads, develops, and holds teams accountable for productivity, quality, performance improvement, and consistent workflow execution.
• Payer Escalation & Resolution:
  Navigates complex payer, carrier, attorney, and reimbursement disputes through effective escalation, negotiation, and relationship management.
• Strategic Problem Solving &
  
  Collaboration:
  
  Identifies root causes, recommends corrective actions, and partners across operational, financial, clinical, payer, and executive stakeholders to drive sustainable improvement.
• Revenue Governance and Oversight:
  Leads efforts to identify and resolve internal and external revenue risks, process gaps, and operational barriers that may impact billing accuracy, reimbursement, or revenue performance. Establishes clear governance, accountability, and escalation pathways to support timely resolution and prevent recurring issues.

• Lead recovery operations across Commercial, Workers' Compensation, Personal Injury, and other assigned reimbursement segments.
• Establish departmental recovery strategies, priorities, goals, and performance expectations.
• Ensure consistent execution of follow-up, denial management, appeal, escalation, and recovery workflows.
• Monitor and improve recovery outcomes through proactive management of team activities and performance.

• Develop recovery strategies by payer, denial category, carrier, attorney, business line, and aging segment.
• Evaluate recovery opportunities and prioritize efforts based on financial impact and probability of success.
• Review high-dollar, high-risk, complex, or escalated reimbursement issues.
• Direct resolution efforts for significant payer disputes and reimbursement barriers.
• Establish and maintain payer escalation frameworks and resolution pathways.

• Oversee denial management and appeal activities across all recovery teams.
• Ensure timely submission of appeals, reconsiderations, corrected claims, and supporting documentation.
• Evaluate denial trends and identify opportunities for prevention and performance improvement.
• Support development of enterprise denial prevention strategies.
• Monitor appeal success rates and reimbursement outcomes.

• Monitor recovery dollars, collections performance, AR aging, appeal outcomes, and reimbursement trends.
• Forecast recovery opportunities and financial impacts.
• Identify and communicate reimbursement risks and performance barriers.
• Develop action plans designed to improve organizational recovery performance.
• Support executive reporting and departmental scorecard development.

• Lead hiring, onboarding, training, coaching, and performance management activities.
• Establish productivity, quality, and accountability standards.
• Promote career development and succession planning.
• Foster a culture of ownership, problem solving, and continuous improvement.
• Support cross-training and knowledge-sharing initiatives.

• Analyze root causes of reimbursement failures and collaborate with operational teams to address systemic issues.
• Partner with Financial Reconciliation, Billing Operations, Payer Relations, and Revenue Systems Strategy & Business Optimization leaders to reduce future revenue leakage.
• Support system enhancements, workflow redesign, and automation initiatives.
• Evaluate effectiveness of implemented process improvement efforts.
• Contribute to enterprise revenue performance initiatives.

• Maintain policies, procedures, standards, and controls related to recovery operations.
• Ensure timely and accurate documentation of recovery activities and payer communications.
• Monitor compliance with regulatory requirements, payer guidelines, and internal policies.
• Support internal audits and…