Rocky Mountain Laboratories · 1 day ago
Denials & Appeals Lab Billing Supervisor
United States
Full-time
Remote
Mid, Senior Level
$50K/yr - $60K/yr
3+ years expRocky Mountain Laboratories is a leading clinical and molecular diagnostics laboratory providing comprehensive testing and billing services to healthcare providers nationwide. The Denials & Appeals Billing Supervisor oversees daily denial management and appeals operations, focusing on payer denials, underpayments, and appeal submissions, while driving revenue recovery and denial prevention.
BiotechnologyMedicalTest and Measurement
Responsibilities
Oversee day-to-day denials and appeals operations, including:
Review, prioritization, and resolution of payer denials and underpayments
Preparation, submission, and tracking of first-level, second-level, and advanced appeals, including payer reconsiderations
Follow-up on appealed claims to ensure timely adjudication and payment
Identification and correction of claim issues prior to resubmission
Manage and prioritize denials and appeals work queues to meet turnaround, accuracy, and recovery benchmarks
Serve as the primary escalation point for complex, high-dollar, or recurring denials
Analyze denial trends and perform root cause analysis by payer, denial reason, and error type
Partner with front-end, coding, billing, and payment posting teams to reduce preventable denials
Ensure appeals are compliant with payer policies, timelines, and documentation requirements
Interpret payer policies, LCDs/NCDs, and medical necessity guidelines as they relate to laboratory billing
Develop and maintain SOPs, workflows, and reference documentation for denials and appeals processes
Provide training, guidance, and performance feedback to denials and appeals staff
Assist with onboarding and training new team members
Monitor and report on denial rates, appeal success rates, recovery trends, and repeat denial patterns
Collaborate with Revenue Cycle leadership and IT on workflow improvements, automation, and reporting enhancements
Participate in system upgrades, enhancements, and user acceptance testing as needed
Ensure compliance with payer rules, audit standards, and internal controls
Perform additional supervisory or operational duties as assigned
Qualification
Required
Minimum 3–4 years of hands-on denials and appeals experience, with direct ownership of appeal submissions and follow-up
Laboratory billing experience (toxicology, molecular, PCR, or similar)
Direct experience resolving medical necessity, bundling, frequency, coverage, eligibility, and timely filing denials
Experience managing payer underpayments and misprocessed claims
AdvancedMD (AMD) experience within denials or A/R workflows
Strong understanding of payer policies, appeal timelines, and documentation requirements
Demonstrated experience performing denial trend analysis and recommending corrective actions
Proficiency with billing systems, clearinghouses, and payer portals
Strong attention to detail, organization, and problem-solving skills
Ability to work independently and lead workflows in a fully remote environment
Preferred
Experience developing or improving denial prevention strategies
Familiarity with payer-specific escalation and appeal processes
Experience collaborating with front-end billing, coding, or claim submission teams
Prior experience mentoring or informally leading denials or A/R staff
Experience supporting automation or reporting related to denial tracking and recovery
CPC or similar billing/coding certification
Associate's or Bachelor's degree in Business, Healthcare Administration, or related field
Benefits
Health, Dental, and Vision Insurance
Paid Time Off (21 days annually for full-time team members)
7 Paid Holidays
401(k) with 50% Company Match up to 6%
Health Savings Account (HSA)
Short-Term & Long-Term Disability (RML covers 60% of STD premium)
Voluntary Life and AD&D Insurance
100% Company-Funded Employee Assistance Program (EAP)
Company
Rocky Mountain Laboratories
Rocky Mountain Laboratories offers medical lab testing in molecular diagnostics, chemistry, hematology, and immunology.
11-50 employees
Funding
Current Stage
Early StageRecent News
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