Manager of Billing Denials and Appeals - Revenue Cycle Management M - F

Salary Range: $ - $

The Manager of Billing Denials and Appeals is accountable for leading Washington Health’s comprehensive strategy to prevent, manage, and overturn payer denials while maximizing reimbursement across all payer classes. This is a high-impact, cross-functional leadership role requiring deep expertise in payer regulations, clinical documentation, and revenue cycle operations.

The Manager partners with patient accounting, coding, clinical documentation improvement (CDI), utilization review, case management, and managed care contracting teams to identify denial trends, execute root cause analysis, and drive systemic process improvements. This role is responsible for setting departmental goals, monitoring performance metrics, educating staff on payer-specific requirements, and ensuring full compliance with federal and state regulations while optimizing cash flow and financial outcomes.

Reports to:

Director of Patient Financial Services

• Education
• Licensure
• Work Experience
• Skills/computer/ specific technical
• Other qualifications, miscellaneous
• Specify if qualifications are Required or Preferred

• Bachelor’s degree in Nursing, Health Information Management, Healthcare Administration, or a closely related field required.
• Master’s degree (MHA, MBA, MSN, or equivalent) strongly preferred.
• RN licensure or coding certification (e.g., CCS, CPC) highly preferred.

• Minimum of 5 years of progressive hospital revenue cycle experience, with at least 3 years in a denials management, appeals, or utilization review leadership role.
• Demonstrated experience managing teams and leading cross-functional improvement initiatives in a hospital or integrated health system environment.
• In-depth knowledge of payer regulations, reimbursement methodologies (DRG, APC, per diem, fee schedule), CMS guidelines, and commercial payer contract interpretation.
• Hands-on experience with government audit processes (RAC, MAC, OIG) and payer dispute resolution.
• Proven track record of measurably reducing denial rates and improving appeal overturn rates.

• Certified Revenue Cycle Professional (CRCP) or Certified Revenue Cycle Representative (CRCR)
• Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT)
• Registered Nurse (RN) — if applicable
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) — if applicable

Key Components: assess, plan, evaluate, demonstrate initiative, quality of work, productivity

The Manager of Billing Denials and Appeals is expected to set clear goals, track measurable outcomes, and hold the team accountable for performance. Success in this role is defined by tangible improvements in denial rates, appeal overturn rates, and revenue recovery.

• Establish and achieve departmental targets for denial rate reduction, appeal overturn rates, and days-to-resolution, reporting progress to revenue cycle leadership quarterly.
• Lead root cause analysis initiatives that result in measurable, sustained decreases in preventable denials across clinical, technical, and administrative categories.
• Drive financial recovery efforts by ensuring high-dollar and complex denials are prioritized, worked, and resolved within payer-defined timelines.
• Monitor team productivity and quality metrics, implementing corrective action plans when performance falls below established benchmarks.
• Deliver documented cost savings and revenue recovery results through successful audit defense and appeal outcomes.
• Set individual and team performance goals aligned with organizational revenue cycle objectives and…