Senior Manager- Denials Management Operations

The Senior Manager – Denials Management Operations plays a critical leadership role in the execution and performance of day-to-day denial management activities across a large, enterprise health system. This position oversees multiple specialized teams responsible for managing incoming, priority, and resolution-stage denials, ensuring optimal performance in alignment with organizational goals and compliance requirements.

The ideal candidate brings strong operational leadership, the ability to manage multi-skilled teams, and a firm grasp of key revenue cycle KPIs. The Senior Manager will also collaborate closely with PRIZM teams to align on denial trends, provide feedback loops, and contribute to data-informed performance improvement. Additionally, this role will be a key point of contact for teams working with external global vendors, ensuring quality, efficiency, and accountability.

Key Responsibilities:

• Direct daily operations of denials management teams including those focused on new incoming denials, priority denials, and denial resolution.
• Manage a team of Senior Representatives and Representatives across multiple functions and locations.
• Ensure departmental and enterprise KPIs are tracked, met, and continuously improved (e.g., denial overturn rates, days to resolve, appeal success rates).
• Partner closely with the PRIZM team to monitor denial trends, identify feedback loops, and guide data-driven improvements.
• Provide frontline feedback on denial patterns to upstream departments, including clinical documentation, patient access, and billing teams.
• Collaborate with enterprise vendor management teams and global service providers to align on operational execution, productivity, and quality expectations.
• Develop team performance metrics, conduct regular reviews, and implement performance improvement strategies where necessary.
• Ensure all activities are compliant with payor guidelines, organizational standards, and applicable regulatory requirements.
• Act as a coach and mentor to staff, fostering growth and engagement through ongoing development and feedback.
• Maintain a strong operational rhythm with cross-functional stakeholders, ensuring escalation pathways are in place and effectively utilized.
• Support broader revenue cycle initiatives, participating in committees, task forces, or workgroups as needed.

 

Required:

• Bachelor’s degree in Business, Healthcare, Finance, or related field, and 10 years of relevant experience including 5 years of leadership experience
  OR
  14 years of relevant experience in lieu of a degree, including at least 5 years managing people and operations.
• Proven ability to manage high-volume operational teams in a complex healthcare environment.
• Deep understanding of denial workflows, appeals, root cause analysis, and operational KPIs.
• Demonstrated success managing people, driving performance improvement, and optimizing team structures.
• Experience working in or closely with revenue cycle systems, including denial management platforms like PRIZM.
• Excellent communication and relationship-building skills across administrative, clinical, and vendor teams.

Preferred:

• Experience managing multi-site or remote teams, including global vendor operations.
• Familiarity with EPIC, and other denial and appeal tracking tools.
• Prior work in a large academic health system or matrixed health enterprise.
• Involvement in denial prevention workgroups, HFMA task forces, or payer-provider collaboration initiatives.

Key Competencies:

• Operational Execution & Prioritization
• Team Leadership & Talent Development
• Metrics-Driven Accountability
• Stakeholder Coordination & Feedback Loop Creation
• Vendor Oversight & Partnership Management
• Revenue Cycle Process Knowledge
• Strong Communication & Situational Awareness

Additional Information:

• This position may require occasional travel based on operational needs or vendor coordination.
• Ability to operate in a fast-p