Director, Payer Denials Management

The Director, Payer Denials Management will lead the strategic and operational oversight of payer denials for a high-volume toxicology laboratory. This role is responsible for driving resolution of denied claims, conducting root cause analysis, managing payer appeals, and implementing prevention strategies. He or she will collaborate on coding, billing, compliance, and client services to reduce denial rates and maximize reimbursement outcomes.

Essential Duties And Responsibilities

• Team Leadership: Manage and mentor a high-performing team focused on timely and effective denial resolution
• Performance Management: Define team goals, KPIs, and performance benchmarks aligned with revenue recovery objectives
• Denial Analytics: Monitor and analyze denial trends across commercial and government payers; identify root causes and recurring issues
• Strategic Prioritization: Focus efforts on high-impact denials and develop targeted mitigation plans
• Reporting & Insights: Maintain dashboards and deliver actionable reporting to internal stakeholders and executive leadership
• Appeals Oversight: Develop and refine payer-specific appeal strategies and documentation templates
• Compliance Assurance: Ensure all appeals are compliant, well-supported, and submitted within required timelines
• Cross-Functional Collaboration: Partner with coding, client services, LIS, and registration teams to proactively prevent denials
• Contracting Support: Work with payer contracting teams to resolve reimbursement discrepancies and clarify payer rules
• Regulatory Alignment: Ensure all denial management practices adhere to CMS, OIG, and payer-specific regulations
• Policy Monitoring: Stay informed on evolving payer guidelines, including MUEs, NCCI edits, and LCD/NCD policies
  
  

Successful Candidates Must Possess

• Bachelor’s Degree in Business, Finance or related discipline strongly preferred; candidates with a high school diploma and a minimum of twelve (12) years of documented, successful denial management and leadership experience will be considered
• A minimum of seven (7) years of experience in revenue cycle or denials management, with at least five (5) years in a supervisory or leadership role required
• In-depth knowledge of CPT, ICD-10, HCPCS coding systems, and denial codes required
• Strong working knowledge of payer portals, appeals workflows, and billing application platforms required
• Exceptional analytical, organizational, and communication skills
• Proficient in Excel and familiar with data visualization/reporting tools like Power BI, Databricks or equivalent platforms
• Experience in a laboratory or diagnostic testing environment is highly preferred
  
  

Aegis Sciences Corporation is and Equal Opportunity Employer