Associate Director, Billing Strategy - Denials & Appeals

📋 Description

• Lead denial management and appeals strategy across payer types.
• Define overturn rates, appeal timelines, and recovery performance.
• Internal expert on payer policies and medical necessity for lab testing.
• Interpret payer policies and guide teams on defending medical necessity in appeals.
• Identify payer behavior patterns to inform contracting strategy and escalation.
• Translate denial workflows into system logic; support automation buildout.

🎯 Requirements

• 8–12+ years in healthcare Revenue Cycle Management focused on denials/appeals.
• Expertise in laboratory billing, CPT coding, and reimbursement.
• Strong knowledge of commercial, Medicare, Medicaid, and managed care policies.
• Experience with BPO or offshore RCM vendors.
• Strong analytical skills with Power BI, Excel, SQL, or Snowflake.
• Experience leading cross-functional initiatives and influencing stakeholders.

🎁 Benefits

• Comprehensive medical, dental, vision, life and disability plans.
• Fertility care benefits and free testing for employees and dependents.
• Pregnancy/baby bonding leave; 401k and commuter benefits.
• Generous employee referral program.