Billing Strategy Lead, Denials and Appeals

We are seeking a Billing Strategy Lead, Denials & Appeals to provide cross-functional project management across critical strategic programs focused on revenue cycle operations—particularly denials and appeals management. This role will support the Billing Strategy leadership team by managing high-impact projects, leading vendor transitions, and driving initiatives to enhance reimbursement outcomes. The ideal candidate will be highly data-savvy, experienced in healthcare revenue cycle processes, and skilled at managing multiple stakeholders, timelines, and deliverables in a dynamic environment.

PRIMARY RESPONSIBILITIES:

• Lead strategic initiatives related to denials and appeals, with an emphasis on transitioning offshore billing operations in-house and standing up new billing workflows or teams.
  
  
• Act as a subject matter expert in revenue cycle and healthcare reimbursement, especially in backend functions such as appeals, denials, and claims workflows.
  
  
• Drive collaboration across Billing Strategy, Operations, Data Analytics, and Engineering teams to ensure deliverables are met, timelines are tracked, and blockers are addressed.
  
  
• Manage and audit vendors; support vendor transition planning, oversight, and implementation of new billing technologies or processes.
  
  
• Translate data into operational insights through the use of dashboards, reporting, and Business Intelligence tools (Excel, PowerBI, or Tableau); provide data-driven insights to aid in operational strategy.
  
  
• Utilize project planning and tracking using tools such as Drawio, Smartsheet, or other project trackers to ensure accountability across teams and deliver clear, concise status updates to leadership.
  
  
• Organize and lead recurring cross-functional meetings to review project progress, manage risks, and ensure alignment on priorities and timelines.
  
  
• Provide high-quality documentation and communications including project plans, audit summaries, transition roadmaps, and status updates.
  
  
• Balance hands-on management of projects with strategic planning—pivoting and adapting as needed to meet evolving business demands.
  
  

QUALIFICATIONS:

• Bachelor’s degree in a relevant field (e.g., Biology, Health Administration, Business) or equivalent years of professional experience.
  
  
• 2–4 years of project or program management experience in healthcare or biotech, and at least 5 years of direct experience in revenue cycle operations and denials management.
  
  
• Proven experience with denials and appeals management and implementing process improvements in a healthcare reimbursement setting.
  
  
• Experience leading large initiatives involving vendor transitions, standing up new internal teams, or shifting billing operations in-house.
  
  
• Strong experience working with data and KPIs; proficiency with Excel is required, and familiarity with SQL, PowerBI or Tableau is strongly preferred.
  
  
• Certification or formal training in Program or Project Management (PMP, Agile, etc.) is a plus.
  
  
• Experience building Gantt charts, timelines, and using project tracking software.
  
  

KNOWLEDGE, SKILLS, AND ABILITIES:

• Deep understanding of healthcare reimbursement, claims processing, and appeals workflows.
  
  
• Excellent interpersonal and communication skills, with the ability to convey updates and data-driven insights to both operational teams and executive leadership.
  
  
• Strong organizational, problem-solving, and time management abilities; thrives in fast-paced, ambiguous environments with shifting priorities.
  
  
• Comfortable managing up, holding cross-functional partners accountable, and driving project progress independently.
  
  
• Ability to translate project status, KPIs, and priorities into clear documentation and updates for stakeholders.
  
  

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