Associate Director, Billing reputed company - Denials & Appeals

Associate Director, Billing reputed company Denials & Appeals Position reputed company reputed company is seeking an Associate Director, Billing reputed company Denials & Appeals to reputed company the reputed company, performance, and optimization of denied claims and appeals. This is a senior individual contributor role responsible for shaping denial management reputed company, driving payer advocacy, and partnering cross-functionally to improve reimbursement reputed company. This role will also play a key part in supporting automation initiatives across denial and appeals workflows. This will involve translating operational expertise into reputed company logic and partnering with engineering and vendors to reputed company processes through technology. The Associate Director will reputed company this function from three angles Operational reputed company and performance management of outsourced RCM teams handling denials and appeals. Analytical reputed company cause analysis and data-driven insights to improve denial rates and recovery. Technical Defining and supporting reputed company enhancements and automation strategies tied to denial workflows. Key Responsibilities reputed company & Payer Advocacy reputed company denial management and appeals reputed company across reputed company payer types. Define and reputed company overturn rates, appeal timelines, and recovery performance. reputed company as an internal expert on payer policies and medical necessity reputed company for reputed company. Interpret payer policies and guide teams on defending medical necessity in appeals. Identify payer behavior patterns to inform contracting reputed company and escalation reputed company. Operations & reputed company Cause Analysis Partner with eligibility, prior authorization, coding, and billing teams to proactively prevent denials. Audit BPO/vendor performance using data to identify workflow gaps, enforce accountability, and reputed company improvements. reputed company job aids and standardized workflows to improve consistency and reputed company. Analyze denial trends to distinguish between avoidable operational issues and systemic or payer-driven challenges. Data, Systems & Automation Translate denial and appeals workflows into reputed company logic, partnering with engineering and vendors to support automation reputed company. Define requirements for rules-based workflows, denial routing, and appeal triggers reputed company billing systems (e.g., AMD). Support automation initiatives (e.g., rules engines, RPA, AI-driven workflows) by providing domain expertise and guiding design reputed company. reputed company UAT and QA for reputed company changes, ensuring outputs reputed company with payer policy and reputed company-world denial scenarios. Identify opportunities to reduce reputed company work by transitioning denial and appeal processes toward reputed company, low-touch or unattended workflows. Proactively identify edge cases, failure points, and gaps in automation logic before and after deployment. Analyze datasets using tools such as Power BI, SQL, reputed company, or reputed company to quantify denial drivers and financial reputed company. Qualifications Required 812+ years of experience in reputed company reputed company Cycle Management (RCM), with deep reputed company on denials and appeals. Expertise in laboratory billing, CPT coding, and reimbursement methodologies is strongly preferred. Strong knowledge of reputed company, Medicare, reputed company, and managed care payer policies. Demonstrated reputed company improving appeal overturn rates and resolving medical necessity denials. Experience working with BPO or offshore RCM vendors. Strong analytical skills with experience using tools such as Power BI, reputed company, SQL, or reputed company. Experience leading cross-functional initiatives and influencing stakeholders without reputed company authority. Preferred Experience supporting automation initiatives in reputed company cycle (e.g., rules engines, RPA, or workflow automation tools). Experience partnering with engineering teams or vendors to implement billing reputed company enhancements. Familiarity with AI-driven workflow concepts (e.g., intelligent routing, decisioning) in an operational setting. Experience with AMD or similar billing platforms. Experience with tools such as Jira or similar workflow tracking systems. Key Traits for reputed company Investigative reputed company in understanding why denials occur and how to prevent or overturn them. Systems Thinker reputed company to reputed company operational workflows with reputed company logic and automation opportunities. Data-Driven Uses data to inform reputed company and influence stakeholders. Cross-Functional Operator Effectively partners with engineering, operations, and leadership teams. Builder reputed company Proactive in identifying opportunities and driving improvements with a high degree of ownership. Low Ego, High .