Supervisor-Denials & Appeals-ABQ

The Supervisor, Denials and Appeals leads the daily operations of the Denials and Appeals team, ensuring timely and accurate resolution of accounts in alignment with Presbyterian Health Services (PHS) policies, regulatory requirements, and payer guidelines. This role focuses on optimizing denial overturn rates, reducing denial volumes, and improving cash collections through strategic oversight, process improvement, and team leadership. The supervisor collaborates with internal departments and external partners to identify root causes of denials, implement corrective actions, and drive continuous improvement while fostering a high-performing, customer-focused team environment.

Key Responsibilities

• Supervise the day-to-day operations of the Denials and Appeals team, ensuring accounts are processed in accordance with established quality and performance standards.

• Monitor system-generated reports, quality audits, and work queues to evaluate performance and identify opportunities for improved efficiency and effectiveness.

• Develop and implement strategies to improve denial overturn rates, reduce denial volumes, and enhance overall cash collections.

• Assist leadership in ensuring all processes are documented in accordance with PHS standards to support regulatory compliance and audit readiness.

• Identify, investigate, and resolve complex denial issues, ensuring coordination across Professional Billing (PB) and Hospital Billing (HB) and all impacted stakeholders.

• Serve as a subject matter expert and resource for internal and external inquiries, promoting clear, timely, and effective communication.

• Review inventory and workload trends daily/weekly to prioritize work, allocate resources, and establish team assignments.

• Participate in denial management workgroups and collaborate with cross-functional teams to improve operational processes and reduce denial rates.

• Lead team performance, including hiring, coaching, counseling, and disciplinary actions, and partner with leadership to implement corrective action plans when needed.

• Foster a high-performing, customer-focused team by promoting continuous learning, reviewing payer policy updates, and ensuring compliance with all regulatory and payer requirements.

• Perform other duties as assigned and support Patient Financial Services (PFS) projects as needed.

• One to two years of college-level coursework OR three years of healthcare business office experience in lieu of college education

• Minimum of two years of experience in healthcare billing and/or collections required

• Proficient knowledge of insurance billing and reimbursement methodologies

• Working knowledge of medical terminology, ICD-10, CPT, and HCPCS coding systems

• Familiarity with CMS-1500 and UB-04 claim forms

• Experience with 837 electronic claims processing and 835 electronic remittance processing

• Demonstrated ability to communicate effectively, both verbally and in writing, with customers, providers, and peers

• Strong organizational, interpersonal, and time management skills

• Ability to work independently and effectively in a fast-paced environment