Associate Director, Billing Strategy - Denials & Appeals

Role: Senior leader overseeing denial management and appeals strategies within revenue cycle management for a biopharma laboratory testing company. Objectives include optimizing reimbursement, reducing denial rates, and enhancing automation in denial workflows. Responsibilities encompass developing payer advocacy strategies, analyzing root causes of denials, managing outsourced RCM vendor performance, and partnering with engineering teams to implement automation solutions like rules engines and RPA. The role involves interpreting payer policies, guiding internal teams on medical necessity appeals, and leveraging data tools (Power BI, SQL, Snowflake) to identify denial patterns and financial impacts. Qualifications include 8–12+ years in healthcare RCM with expertise in laboratory billing, CPT coding, and payer policies across commercial, Medicare, Medicaid, and managed care. Experience with automation initiatives, billing platforms like AMD, and working with offshore vendors is preferred. The position demands strong analytical, cross-functional collaboration skills, and a proactive, investigative approach to system and process improvements. The role is remote within the USA, with a compensation range of $132,100–$165,100. High-value specifics include focus on lab testing reimbursement, automation in denial workflows, and cross-disciplinary stakeholder engagement within a clinical diagnostics context.