US Denials Manager (BCBS Focus – Player-Coach)
Position Overview
We are seeking an experienced US Denials Manager Consultant to lead and execute denials management for large, multi-specialty group practices. This player-coach role requires deep, hands-on expertise in denial resolution—particularly with Blue Cross Blue Shield (BCBS) plans—while building strong denial management capabilities within offshore teams.
Key Responsibilities
Denials Management & Resolution
• Own end-to-end denials management while actively resolving complex denials.
• Handle denials related to medical necessity, authorizations, eligibility, coding, modifiers, and reimbursement disputes.
• Manage appeal processes including written appeals, peer-to-peer reviews, and payer escalations.
• Drive measurable improvements in denial rates, appeal overturn percentages, and cash recovery.
Root Cause Analysis & Process Improvement
• Conduct root-cause analysis and denial trending by payer, plan, specialty, CPT/ICD, provider, and location.
• Build, implement, and enforce denial SOPs, playbooks, and appeal templates.
• Partner with coding, authorization, front-end, and physician leadership to address systemic denial drivers.
• Ensure documentation accuracy, compliance, and audit readiness. Offshore Team Leadership
• Coach, train, and upskill offshore denial teams.
• Monitor productivity, quality, and outcomes using KPIs and dashboards. Systems & Tools
• Experience with denial work queues, payer portals, correspondence tools, and reporting dashboards.
• Proficiency with eClinicalWorks or similar EHR/practice management systems preferred.
Qualifications
• 8–15 years of experience in US healthcare denials management.
• Extensive hands-on experience managing BCBS denials.
• Proven success in player-coach roles resolving complex, high-dollar denials.
• Strong experience building denial workflows, SOPs, and appeal strategies.
• Strong analytical, communication, and coaching skills.
• Solid understanding of billing compliance, HIPAA, and payer regulations. Engagement Type
• US-based consultants only.
• 60–90 day engagement
Pay: $75,000.00 - $80,000.00 per year
Work Location: Remote
Apply Now
Apply Now
We are seeking an experienced US Denials Manager Consultant to lead and execute denials management for large, multi-specialty group practices. This player-coach role requires deep, hands-on expertise in denial resolution—particularly with Blue Cross Blue Shield (BCBS) plans—while building strong denial management capabilities within offshore teams.
Key Responsibilities
Denials Management & Resolution
• Own end-to-end denials management while actively resolving complex denials.
• Handle denials related to medical necessity, authorizations, eligibility, coding, modifiers, and reimbursement disputes.
• Manage appeal processes including written appeals, peer-to-peer reviews, and payer escalations.
• Drive measurable improvements in denial rates, appeal overturn percentages, and cash recovery.
Root Cause Analysis & Process Improvement
• Conduct root-cause analysis and denial trending by payer, plan, specialty, CPT/ICD, provider, and location.
• Build, implement, and enforce denial SOPs, playbooks, and appeal templates.
• Partner with coding, authorization, front-end, and physician leadership to address systemic denial drivers.
• Ensure documentation accuracy, compliance, and audit readiness. Offshore Team Leadership
• Coach, train, and upskill offshore denial teams.
• Monitor productivity, quality, and outcomes using KPIs and dashboards. Systems & Tools
• Experience with denial work queues, payer portals, correspondence tools, and reporting dashboards.
• Proficiency with eClinicalWorks or similar EHR/practice management systems preferred.
Qualifications
• 8–15 years of experience in US healthcare denials management.
• Extensive hands-on experience managing BCBS denials.
• Proven success in player-coach roles resolving complex, high-dollar denials.
• Strong experience building denial workflows, SOPs, and appeal strategies.
• Strong analytical, communication, and coaching skills.
• Solid understanding of billing compliance, HIPAA, and payer regulations. Engagement Type
• US-based consultants only.
• 60–90 day engagement
Pay: $75,000.00 - $80,000.00 per year
Work Location: Remote
Apply Now
Apply Now