Prestige Practice Management & IT Services LLC · 1 week ago
Denial Management Lead
United States
Full-time
Remote
Mid, Senior Level
3+ years expPrestige Practice Management & IT Services LLC is seeking a Denial Management Lead to oversee the denial management function. This role is responsible for ensuring timely resolution of denied claims and providing leadership to the denial management team while collaborating cross-functionally to strengthen revenue cycle performance.
Consumer SoftwareHealth CareManagement Consulting
Responsibilities
Lead the end-to-end denial management process, including review, prioritization, appeal submission, and payer follow-up
Review and resolve complex, high-dollar, or escalated denials and determine appropriate appeal strategies
Monitor denial trends and perform root cause analysis by payer, provider, service type, and workflow
Develop, track, and report on denial metrics, KPIs, and performance outcomes
Provide day-to-day leadership, coaching, and guidance to denial management team members
Ensure timely and accurate appeal submissions in accordance with payer and regulatory requirements
Collaborate with billing, coding, eligibility, credentialing, and operations teams to address root causes and prevent future denials
Serve as a primary point of contact for denial-related escalations and payer communications
Maintain up-to-date knowledge of payer rules, reimbursement guidelines, and regulatory changes
Assist with audits, documentation requests, and internal quality improvement initiatives
Ensure all denial-related activity complies with HIPAA, payer guidelines, and company policies
Perform all other duties as assigned
Qualification
Required
Revenue cycle management workflows and best practices
Medical billing, claim adjudication, and denial resolution processes
Payer rules, appeal requirements, and reimbursement methodologies
CPT, ICD-10, and HCPCS coding concepts
Healthcare compliance standards, including HIPAA
Principles and practices of supervision and leadership
Analyze denial data and identify trends and root causes
Communicate effectively both orally and in writing
Lead, coach, and support team members
Prioritize workload and manage multiple deadlines
Work independently with minimal supervision
Maintain confidentiality and exercise sound judgment
Minimum of 3–5 years of experience in denial management or revenue cycle operations
Certified Professional Coder (CPC) required
Preferred
Prior lead or supervisory experience
Company
Prestige Practice Management & IT Services LLC
Prestige Practice Management & IT Services is a revenue cycle management company founded in 2013.
2-10 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase