Manager - Denial Management (Remote)

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

The Manager, Denial Management provides strategic leadership and operational oversight for a team of Denial Specialists and is accountable for the timely and accurate resolution of denied and underpaid claims in accordance with current contracts, federal regulations, and SHC policies. This role is responsible for the performance of assigned Accounts Receivable associated with denials, including prevention, recovery, and appeal strategies across hospital and physician services. The Manager serves as a subject matter expert, leads complex denial operations, partners with internal and external stakeholders to address payer trends, and drives continuous improvement to optimize reimbursement and reduce avoidable denials. In addition, the Manager builds and develops a high-performing team by recruiting and onboarding talent; providing ongoing coaching, feedback, and competency-based training; and conducting performance management that aligns individual goals with department objectives. The Manager establishes clear productivity expectations and standard work, sets individual and team targets, and leverages reports and dashboards to monitor timeliness, overturn rates, aged A/R, and appeal quality. The role maintains a robust quality assurance program, including routine audits and documentation standards in Epic and related systems, ensuring accuracy, compliance, and consistency; uses audit results and payer trend analyses to inform targeted education, process improvements, and workload balancing; and proactively removes barriers to sustain productivity and quality outcomes.

Locations

Stanford Health Care

What you will do

• Lead, develop, and oversee a team of Denial Specialists; provide coaching, training, and performance management to achieve departmental goals and quality standards.
• Own performance outcomes for assigned denial-related Accounts Receivable, including recovery, overturn rates, aging, write-offs, and compliance with appeal timelines.
• Establish daily management routines, prioritize work queues, and ensure timely follow-up on high dollar and complex denials and underpayments across hospital (HB) and professional (PB) billing.
• Conduct and direct root-cause analysis of denial trends to identify mitigation, prevention, and escalation opportunities; design and implement corrective action plans.
• Oversee appeals and payer escalations; coordinate with Managed Care, Legal, Compliance, and Clinical leaders to interpret contract terms and support successful resolution.
• Develop, track, and report operational and financial KPIs (e.g., denial rate, initial denial overturn rate, days in A/R, net recovery); present insights and recommendations to leadership.
• Collaborate with Revenue Cycle stakeholders (Patient Financial Services, Coding, CDI, Case Management, HIM, Access Services, Ambulatory operations) to address internal process issues and external payer behavior.
• Ensure accurate documentation and audit-ready records in Epic and related systems; uphold privacy and regulatory compliance requirements.
• Standardize workflows, policies, and procedures; lead continuous improvement initiatives and ensure quality and productivity are effectively monitored and managed.
• Maintain effective relationships with payers and partner on remediation of systemic issues impacting reimbursement.
• Plan and allocate resources, manage staffing levels and skill mix, and contribute to budget development and monitoring for the denial management function.
• Serve as a key resource to leadership for problem-solving difficult issues, analyzing complex accounts, and addressing training needs across the organization.
• Help develop and implement denial prevention recovery strategies, workflows, and playbooks and monitor their effectiveness through regular KPI reporting.
• Monitor payer policy changes, national guidelines, and CMS/Medicare/Medicaid updates to ensure compliance and timely adjustment of practices.
• Maintain denial dashboards, action plans, and performance reports for leadership review.
• Prepare denial reports and summary findings of analysis for department leadership; maintain clear documentation of analyses and outcomes; escalate systemic risks and barriers as appropriate.

Education Qualifications

• Bachelor's degree in Business, Health Care Administration, Finance, or a related field or equivalent combination of education/certifications & experience.

Experience Qualifications

• Seven (7) years of progressively responsible and directly related work experience in healthcare revenue cycle, with a minimum of four (4) years of direct experience in denial management.
• Three (3) years of leadership experience supervising teams or managing operations in denial resolution or related revenue cycle functions.

Required Knowledge, Skills and Abilities

• Working knowledge of government and non-government payer requirements, reimbursement rules, laws, and regulations that govern billing/collection activities.
• Working knowledge of Epic Hospital Billing (HB) and/or Professional Billing (PB); proficiency in Epic reporting preferred.
• Working knowledge of medical terminology, CPT-4, ICD-10, HCPCS, and modifiers, and how these items drive reimbursement.
• Ability to analyze and develop solutions to complex problems, including independently identifying problems through data analysis
• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
• Strong analytical and problem-solving skills, with good judgment, attention to detail, and thorough follow-through; ability to interpret complex contracts and payer policies.
• Demonstrated leadership skills, including staff development, performance management, change management, and the ability to build cross-functional partnerships.
• Excellent verbal and written communication skills; ability to present complex data clearly to stakeholders and executive leadership; effective negotiation skills for payer escalations.

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family's perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $70.52 - $93.43 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.