Associate Director, Billing Strategy – Denials & Appeals

Job Description:

• Lead denial management and appeals strategy across all payer types
• Define and track overturn rates, appeal timelines, and recovery performance
• Serve as an internal expert on payer policies and medical necessity criteria for laboratory testing
• Interpret payer policies and guide teams in defending medical necessity in appeals
• Identify payer behavior patterns to inform contracting strategy and escalation pathways
• Partner with eligibility, prior authorization, coding, and billing teams to proactively prevent denials
• Audit BPO/vendor performance, identify workflow gaps, enforce accountability, and drive improvements
• Develop job aids and standardized workflows
• Analyze denial trends to distinguish avoidable operational issues from systemic or payer-driven challenges
• Translate denial and appeals workflows into system logic with engineering and vendors
• Define requirements for rules-based workflows, denial routing, and appeal triggers in billing systems such as AMD
• Support rules engines, RPA, and AI-driven workflow automation initiatives
• Lead UAT and QA for system changes
• Identify opportunities to transition processes toward scalable, low-touch or unattended workflows
• Identify automation edge cases, failure points, and logic gaps before and after deployment
• Analyze datasets using Power BI, SQL, Excel, or Snowflake to quantify denial drivers and financial impact

Requirements:

• 8–12+ years of experience in healthcare Revenue Cycle Management (RCM), with deep focus on denials and appeals
• Expertise in laboratory billing, CPT coding, and reimbursement methodologies
• Strong knowledge of commercial, Medicare, Medicaid, and managed care payer policies
• Demonstrated success improving appeal overturn rates and resolving medical necessity denials
• Experience working with BPO or offshore RCM vendors
• Strong analytical skills with experience using Power BI, Excel, SQL, or Snowflake
• Experience leading cross-functional initiatives and influencing stakeholders without direct authority
• Preferred: experience supporting revenue-cycle automation initiatives
• Preferred: experience partnering with engineering teams or vendors to implement billing system enhancements
• Preferred: familiarity with AI-driven workflow concepts
• Preferred: experience with AMD or similar billing platforms
• Preferred: experience with Jira or similar workflow tracking systems

Benefits:

• Comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents
• Free testing for employees and their immediate families
• Fertility care benefits
• Pregnancy and baby bonding leave
• 401k benefits
• Commuter benefits
• Employee referral program
• Equal Opportunity Employer and inclusive workplace