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[Remote] Denials Management Team Lead - Professional Billing (PB)
Note: The job is a remote job and is open to candidates in USA. ECU Health is a mission-driven academic health care system serving over 1.4 million people in eastern North Carolina. The Revenue Cycle Denials Team Lead provides operational leadership and technical expertise for denial prevention and resolution activities, overseeing workflows to ensure accuracy and compliance.
Responsibilities
- Oversee daily productivity for denial specialists, ensuring timely movement of accounts through Epic WQs (HB/PB)
- Monitor denial volumes, trends, and backlogs using Epic dashboards
- Assign work based on denial type, payer complexity, aging, and team member skill set
- Ensure compliance with timely filing, appeal deadlines, and payer-specific requirements
- Review complex escalated accounts requiring clinical, coding, documentation, or contract interpretation
- Provide subject-matter expertise in: CO-197 Authorization Denials, CO-50 Medical Necessity denials, CO-45 Contractual write-off validation, Coding rejections (modifiers, bundling, NCCI edits), MSP/COB denials, Technical and billing errors, Prior authorization retro auths, Payer-specific remittance interpretation
- Conduct root-cause analysis with leadership and identify systemic issues (training gaps, coding errors, workflow failures, payer trends)
- Collaborate with Billing, Coding, PAS, Clinical Appeals, Revenue Integrity, and Managed Care to address recurring denials
- Ensure specialist prepare complete, accurate, and timely appeals with: Clinical documentation, Coding support, Payer policy evidence, Contract language
- Track performance metrics including: Denials overturn rate, Avoidable denial rate, Appeal success rate, Aging > 90 days, Write-off prevention
- Analyze payer-specific trends and present findings to leadership
- Maintain denial prevention scorecards, dashboards, and audit tools
- Provide technical coaching and daily feedback for denial specialists
- Conduct quality reviews and assist leadership in developing improvement plans for staff
- Train team on payer rule changes, and policy variations
- Support onboarding, education, and cross-training
- Ensure all denial-related actions comply with: Payer contracts, CMS regulations, State requirements, Internal policies, Documentation standards
- Audit staff work for accuracy, compliance, and quality documentation
- Support internal and external audits (Medicare, Medicaid, RAC, payer audits)
- Identify workflow gaps and recommend solutions to reduce denials at the source
- Partner with IT/IS and Epic analysts on enhancements, rules, claim edits, and automation opportunities
- Maintain SOPs, job aids, payer grids, and denial prevention guidelines
Skills
- High school diploma or GED required
- 3 - 5 years of hospital/professional billing, denials, or coding experience
- At least 1 year of informal or formal leadership experience (team lead, senior representative, trainer, QA auditor, or equivalent)
- Experience with multi-hospital and multi-specialty practices
- Strong Epic HB/PB experience required
- Knowledge of CPT, HCPCS, ICD-10, revenue codes, modifiers, and payer reimbursement
- CRCR, CPC, CPMA, or CHAM/CHAA certification
- Deep understanding of payer contracts and clinical documentation
Benefits
- Great Benefits
Company Overview
