US Denials Manager (BCBS Focus – Player-Coach)

Position Overview We are seeking an experienced US Denials Manager Consultant to lead and execute denials management for large, multi-specialty group practices. This player-coach role requires deep, hands-on expertise in denial resolution—particularly with Blue Cross Blue Shield (BCBS) plans—while building strong denial management capabilities within offshore teams. Key Responsibilities Denials Management & Resolution • Own end-to-end denials management while actively resolving complex denials. • Handle denials related to medical necessity, authorizations, eligibility, coding, modifiers, and reimbursement disputes. • Manage appeal processes including written appeals, peer-to-peer reviews, and payer escalations. • Drive measurable improvements in denial rates, appeal overturn percentages, and cash recovery. Root Cause Analysis & Process Improvement • Conduct root-cause analysis and denial trending by payer, plan, specialty, CPT/ICD, provider, and location. • Build, implement, and enforce denial SOPs, playbooks, and appeal templates. • Partner with coding, authorization, front-end, and physician leadership to address systemic denial drivers. • Ensure documentation accuracy, compliance, and audit readiness. Offshore Team Leadership • Coach, train, and upskill offshore denial teams. • Monitor productivity, quality, and outcomes using KPIs and dashboards. Systems & Tools • Experience with denial work queues, payer portals, correspondence tools, and reporting dashboards. • Proficiency with eClinicalWorks or similar EHR/practice management systems preferred. Qualifications • 8–15 years of experience in US healthcare denials management. • Extensive hands-on experience managing BCBS denials. • Proven success in player-coach roles resolving complex, high-dollar denials. • Strong experience building denial workflows, SOPs, and appeal strategies. • Strong analytical, communication, and coaching skills. • Solid understanding of billing compliance, HIPAA, and payer regulations. Engagement Type • US-based consultants only. • 60–90 day engagement Pay: $75,000.00 - $80,000.00 per year Work Location: Remote Apply tot his job