Denials Manager - Patient Financial Services at Cookeville Regional Medical Center – Cookeville, Tennessee

The Denials Manager leads the strategy and execution of denials management activities to maximize reimbursement and minimize revenue leakage. This role oversees the identification, analysis, and resolution of denied claims, including management of the end-to-end appeals process. The Denials Manager drives root cause analysis, implements corrective and preventative workflows, monitors denial trends, and ensures compliance with payer policies and regulatory requirements. In collaboration with Patient Access, Financial Clearance, Coding, Revenue Integrity, Case Management, Utilization Management, Patient Financial Services, Clinical, and payer-facing teams, this role develops sustainable processes that reduce avoidable denials and improve overall revenue cycle performance.

This role operates in a hybrid work environment. While much of the work may be performed remotely, periodic onsite presence is required for key meetings, collaboration sessions, and other business needs. Regular 9am to 5pm schedule.

Education: High School Diploma Required. Bachelors Preferred.

Additional Education Requirements:

-Bachelor’s degree in Healthcare Administration, Business, Finance, or related field preferred
-5+ years of progressive experience in healthcare revenue cycle, with at least 2–3 years focused on denial management, appeals, or AR follow-up
-2+ years of leadership or supervisory experience managing denial analysts, appeals specialists, or revenue cycle teams
- Demonstrated experience analyzing denial trends and implementing corrective action plans that reduce denial rates and improve recovery
-Strong understanding of hospital and/or professional billing workflows, including eligibility, authorization, coding, charge capture, and claim submission
-In-depth knowledge of payer guidelines (commercial, Medicare, Medicaid) and regulatory requirements (CMS, state regulations)
-Proven experience managing denial KPIs such as:
Denials as % of Gross Revenue
Initial Denial Rate
Appeal Success Rate

Experience Requirements:

-5+ years of progressive experience in healthcare revenue cycle, with at least 2–3 years focused on denial management, appeals, or AR follow-up
-2+ years of leadership or supervisory experience managing denial analysts, appeals specialists, or revenue cycle teams
- Familiarity with hospital and/or professional billing workflows
- Advanced ability to analyze denial trends, payer performance, and AR impact
- Strong understanding of revenue cycle KPIs and financial implications of denials
- Ability to interpret large datasets and translate insights into operational action plans
- Proficiency in Excel (pivot tables, formulas, data analysis) and reporting tools
- Ability to identify upstream root causes across eligibility, authorization, coding, billing, and clinical documentation workflows
- Strong process improvement mindset focused on denial prevention, not just recovery
- Ability to design standardized workflows and scalable denial reduction strategies
- Understanding of payer behavior patterns and escalation strategies
- Experience building accountability while maintaining team engagement
- Ability to manage competing priorities in a high-volume environment
- Strong written communication skills for drafting appeal letters and executive summaries
- Skilled in facilitating cross-functional conversations around performance gaps
- Ability to navigate difficult payer conversations professionally and strategically
- Working knowledge of CMS regulations, commercial payer guidelines, and contract language

Avoidable Write-Offs
AR Aging
- Experience using EHR/PM systems (e.g., Epic) and denial tracking tools
- Proficiency in Excel and reporting tools; ability to build dashboards and analyze large datasets
- Strong written communication skills with experience drafting payer appeal letters and executive summaries
- Ability to partner cross-functionally with Patient Access, Financial Clearance, Coding, Revenue Integrity, Case Management, Patient Financial Services, and Clinical teams