Senior Manager - Coding Denials, Hospital Billing

Client Management:

-Establish and maintain trusted client relationships as the primary point of contact for coding denials and hospital billing services.

-Understand client challenges related to coding compliance and billing workflows and recommend tailored solutions.

-Conduct regular meetings to review KPIs, denial trends, billing performance, and strategic opportunities.

Operational Leadership:

-Oversee daily operations of coding denial management and hospital billing workflows ensuring service levels and quality standards are met.

-Lead onshore and offshore teams managing coding denials appeals, payor interactions, documentation reviews, and billing accuracy.

-Ensure compliance with payer regulations and documentation standards to prevent denials and facilitate timely reimbursements.

Process Improvement & Strategic Planning:

-Identify gaps and implement strategies to reduce coding denials and improve hospital billing efficiency.

-Drive continuous improvement initiatives leveraging automation, enhanced workflows, and staff training.

-Partner with analytics and technology teams to develop reporting tools and system enhancements that support coding and billing accuracy.

Performance Monitoring and Reporting:

-Monitor key metrics such as denial rates, coding accuracy, claim resolution times, days in accounts receivable, and collections impact.

-Prepare and present comprehensive dashboards and reports to clients and internal leadership.

-Use data-driven insights to influence operational decisions and client advisory.

Compliance & Quality Assurance:

-Ensure all coding denial and hospital billing processes adhere to applicable regulations and payer guidelines.

-Develop and maintain quality assurance protocols, conducting audits and reviews to guarantee accuracy and compliance.

-Update teams continuously on changes in coding standards (ICD-10, CPT, HCPCS) and payer policies impacting denials.

Qualifications:

-Extensive knowledge of coding denial workflows, hospital billing processes, payer medical necessity guidelines, and coding compliance regulations for at least 10 years.

-Proven ability to lead teams focused on clinical and coding denials resolution and hospital billing activities.

-Strong expertise in payer policies for commercial, Medicare, and Medicaid, including appeals and reimbursement strategies.

-Skilled in analyzing revenue cycle data to identify denial trends, root causes, and opportunities for billing process improvement.

-Experience developing and implementing strategic initiatives that reduce denial volumes, improve cash flow, and enhance coding accuracy.