Sr Mgr, Denials Management

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

• Provides strategic direction for the Denials Management team to ensure operational, financial, productivity, quality, and service level agreement performance metrics are achieved, maintained, and aligned with organizational objectives.

• Leads, coaches, and develops leaders and team members within the denials management downline, ensuring accountability for the quality, timeliness, and accuracy of work performed.

• Ensures accounts placed with assigned teams and vendors are worked within established service level agreements, productivity standards, quality expectations, and payer requirements.

• Develops and executes action plans to improve or maintain performance, address operational gaps, and support continuous improvement across denial prevention, appeal, and recovery workflows.

• Analyzes accounts receivable, denial, payer, and operational trends to identify root causes and provide actionable insights, recommendations, and interventions to improve performance.

• Manages vendor relationships and vendor performance, ensuring vendors meet contractual expectations, service level agreements, quality standards, and operational objectives.

• Partners with internal and external stakeholders, including revenue cycle leadership, Managed Care, payers, vendors, and operational teams, to resolve payer issues, support disputes, and deliver preeminent denial management performance.

• Provides timely, accurate, and actionable data and reporting to support payer escalations, dispute resolution, performance reviews, and strategic decision-making.

• Maintains expertise across the revenue cycle continuum and ensures compliance with applicable regulatory requirements, payer policies, and organizational standards.

• Participates in hiring, training, performance management, succession planning, and talent development to support a high-performing denials management team.

• Performs other duties as assigned

• Strong understanding of healthcare revenue cycle processes, systems, workflows, and performance drivers across the revenue cycle continuum [Required]

• Knowledge of payer policies, denial processes, appeal strategies, CPT, HCPCS, ICD coding systems, and billing regulations for government and commercial payers [Required]

• Advanced analytical and problem-solving skills with ability to interpret accounts receivable, denial, quality, productivity, and financial performance data and convert trends into actionable recommendations [Required]

• Financial acumen with ability to evaluate operational performance, identify risks and opportunities, and act on data to support key financial and operational objectives [Required]

• Operates at a Senior Manager level, achieving results through leadership of others, including managers, supervisors, and experienced professionals [Required]

• Effective leadership, coaching, team development, performance management, and talent development capabilities for leaders and teams [Required]

• Ability to manage teams that may include managers, supervisors, and experienced professionals while promoting accountability, engagement, and service excellence [Required]

• Ability to communicate clearly and professionally with diverse internal and external stakeholders, including senior leadership, Managed Care, payers, vendors, and revenue cycle partners [Required]

• Strong organizational and time management skills with ability to prioritize competing demands in a dynamic, fast-paced healthcare environment [Required]

• Proficiency in Microsoft Office applications, particularly Excel, and ability to use healthcare information systems and denial management technology platforms to monitor and improve performance [Required]

• High level of integrity and discretion in handling confidential information, sensitive business matters, payer issues, and team member information [Required]

• Experience with process improvement methodologies and ability to evaluate workflows, implement improvements, and sustain operational efficiencies [Required]

• Bachelors degree [Required]

• Masters degree [Preferred]

• In Business, Healthcare, Health Services Administration, Health Information Management, Communications, Finance, Accounting, Public Administration, Human Resources, Management, or Marketing

• 3+ years Revenue Cycle experience [Required]

• 3+ years leadership experience [Required]

• An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:

• Bachelors degree AND 3+ years of relevant work experience [Required] OR

• Associates degree AND 5+ years of relevant work experience [Required] OR

• 7+ years of relevant work experience [Required]

• Healthcare Financial Management Association (HFMA) [Preferred]

• Certified Revenue Cycle Rep (CRCR) [Preferred]

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.