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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Revenue Cycle Management with a focus on Denials Management, Appeals Operations, and Payer Recovery. Proven ability to lead teams, ensure compliance, and improve reimbursement performance across healthcare operations.
Highest-signal resume keywords
Revenue Cycle ManagementDenials ManagementPayer RecoveryLeadership ExperienceEpic Revenue Cycle Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Denial AnalyticsContract ComplianceUnderpayment RecoveryReimbursement ReconciliationPayment Variance AnalysisManaged Care ReimbursementThird-Party Follow-UpPayer Accountability InitiativesRevenue Recovery ProjectsCompliance Reviews
Soft Skills
CollaborationProblem-SolvingLeadership
Certifications & Qualifications
HFMA CertificationCRCRRHIARHITCPCLean Six Sigma
Industry Keywords
Healthcare AdministrationPayer ComplianceRevenue IntegrityFinancial CertificationRegulatory Recovery Activities
About the role
Key responsibilities & impact- Provide leadership and oversight for Payer Denials and Recovery operations across Piedmont Healthcare
- Manage day-to-day denial management, appeals, payer escalations, recoupment defense, underpayment recovery, interest payment recovery, reimbursement reconciliations, contract compliance reviews, denial analytics, self-funded TPA payment escalations, revenue recovery projects, and payer accountability initiatives
- Protect earned revenue and recover underpayments
- Defend inappropriate payer recoupments and reduce denial losses
- Ensure payer compliance with contractual and regulatory obligations
- Identify opportunities to improve reimbursement performance
- Collaborate with Revenue Cycle Operations, Managed Care, Revenue Integrity, Finance, Informatics, Compliance, Legal, and payer organizations
- Resolve complex reimbursement issues and support enterprise revenue recovery strategies
- Oversee assigned functional areas including denials, appeals, payer escalations, recovery, compliance reviews, analytics, reconciliations, and regulatory recovery activities
Requirements
What you’ll need- Bachelor's Degree in Business Administration, Healthcare Administration, Finance, Accounting, Health Information Management or related field required, or six (6) years of additional Revenue Cycle experience in lieu of degree
- 5 years of Revenue Cycle experience in denials management, appeals operations, payer recovery, underpayment recovery, contract compliance, revenue integrity, billing/follow-up, managed care reimbursement, third-party follow-up, or payment variance analysis required
- If no degree, a total of eleven (11) years of experience required
- 3 years of leadership or supervisory/management experience required
- 8 or more years of Revenue Cycle experience preferred
- 5 or more years of management experience preferred
- Previous Epic Revenue Cycle experience preferred
- Experience managing two or more specified payer denials, appeals, recovery, compliance, analytics, or dispute-resolution functions preferred
- HFMA Certification, CRCR, RHIA, RHIT, CPC, Lean Six Sigma, or other healthcare financial certification preferred
Benefits
Comp & perks- Remote work arrangement
- Talent Community access for updates on upcoming opportunities