Revenue Cycle Denials Team Lead

Denial Management Team Lead

Summary:

The Denial Management Team Lead provides day-to-day leadership, coaching, and operational oversight for a team responsible for resolving denied, rejected, and underpaid healthcare claims. This role drives team performance against quality, productivity, aging, revenue recovery, and service-level targets; manages workload and escalations; and guides the preparation of accurate appeals, reconsiderations, and claim corrections. The Team Lead also analyzes denial trends, coordinates with payers, providers, coding, clinical, billing, and client stakeholders, and implements corrective actions that maximize reimbursement, reduce revenue leakage, and maintain compliance with payer, client, and regulatory requirements.

Key Responsibilities:

• Lead, coach, and develop Denials Specialists to meet quality, productivity, revenue recovery, aging, and service-level targets.
• Review, prioritize, and resolve denied, rejected, and underpaid claims based on root cause, financial impact, payer requirements, and timely filing deadlines.
• Prepare and submit accurate appeals, reconsiderations, and claim corrections supported by clinical documentation, coding guidelines, contracts, and payer policies.
• Serve as the escalation point for complex denials, payer disputes, and appeal challenges, coordinating with payers and internal stakeholders through resolution.
• Analyze denial trends and recurring issues, partner with coding, billing, clinical, and client teams, and lead corrective and preventive process improvements.
• Monitor team performance, workloads, backlogs, staffing coverage, and quality results; provide feedback, training, and performance improvement support as needed.
• Track recovered revenue and operational metrics, maintain audit-ready records, and communicate results, risks, and action plans to management and stakeholders.
• Ensure adherence to standard operating procedures, client requirements, confidentiality standards, and applicable healthcare regulations.

Qualifications

• College graduate or equivalent (bachelor’s degree preferred)
• Minimum 2 years of experience in healthcare revenue cycle management specifically denial management (denied claims inventory/collection)

• At least 1 year of experience in a team lead, senior specialist, subject matter expert, or comparable leadership role within healthcare revenue cycle or denial management.
• Experience using performance data, quality results, and behavioral observations to identify coaching needs and create individualized development plans.
• Strong analytical and problem-solving skills, with experience interpreting denial trends, operational reports, and performance metrics to drive corrective action.
• Excellent written and verbal communication, stakeholder management, conflict resolution, prioritization, and escalation-handling skills.
• Experience conducting quality reviews, identifying skill gaps, and implementing action plans that improve team accuracy, efficiency, and revenue recovery.
• Ability to interpret payer policies, client procedures, and healthcare compliance requirements and translate them into clear guidance for team members.
• Understanding of ICD-10-CM, CPT, HCPCS, and medical necessity guidelines.
• Working knowledge of Diagnosis-Related Groups (DRGs), including inpatient reimbursement methodologies, coding principles, and their impact on claim denials and appeals.
• Experience with electronic health records (EHR) and billing systems.

• Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or similar certification is a plus.
• Experience in hospital, physician practice, or healthcare outsourcing/BPO environments is preferred.
• Technical appeal writing experience preferred.
• Familiarity with payer portals and denial management software.

• Proficiency in Microsoft Excel, Word, and revenue cycle applications.
• Knowledge of healthcare reimbursement methodologies.

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