Billing Strategy Lead, Denials and Appeals

Position Overview

• Location Type: [Not Specified]
• Employment Type: [Not Specified]
• Salary: [Not Specified]

This role seeks a Billing Strategy Lead, Denials & Appeals to manage strategic programs focused on revenue cycle operations, particularly denials and appeals management. The ideal candidate will be data-savvy, experienced in healthcare revenue cycle processes, and skilled at managing stakeholders and timelines.

Responsibilities

• Lead strategic initiatives related to denials and appeals, including transitioning offshore billing operations in-house and establishing 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.
• 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 with [Not Specified]