Supv Insurance Professional Billing & Complex Denials / Revenue Cycle

At Children’s, the region’s only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team—and join us in providing brighter, healthier tomorrows for the children we serve.


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A Brief Overview
The Supervisor, Insurance Professional Billing and Complex Denials provides leadership and oversight of professional billing reimbursement operations, including insurance and government accounts receivable, claims billing, denial management, appeals, underpayment recovery, and reimbursement optimization. The role is responsible for achieving financial and operational goals through effective management of reimbursement activities, compliance, and payer-related processes.
As a subject matter expert in professional coding, payer reimbursement methodologies, and denial prevention strategies, the supervisor ensures accurate claim submission, regulatory compliance, and maximization of reimbursement opportunities. The position monitors operational performance, analyzes trends, and implements process improvements to enhance efficiency and reimbursement outcomes.
The supervisor provides direct leadership, coaching, and development of staff; establishes productivity and quality standards; ensures adherence to policies and procedures; and supports a culture of accountability and continuous improvement. Additionally, the role serves as a key partner in revenue cycle technology and workflow optimization efforts, coordinating system enhancements, testing, training, and special projects to improve operational effectiveness and financial performance.
Essential Functions

• Leadership and Team Management:
  
  
  
  • Provides direct supervision, leadership, and mentorship to assigned staff, fostering a culture of accountability, collaboration, engagement, and continuous professional development.
  
  
  • Leads and manages daily department operations by prioritizing workloads, allocating resources, coordinating work activities, and ensuring adherence to organizational and departmental goals, performance standards, and service expectations.
  
  
  • Holds self and team members accountable for achieving established objectives, productivity standards, quality metrics, and departmental commitments while effectively adapting to changing priorities and organizational needs.
  
  
  • Conducts all aspects of performance management, including goal setting, coaching, performance evaluations, corrective action, recognition, and employee development planning.
  
  
  • Participates in workforce planning activities, including recruitment, candidate selection, hiring recommendations, onboarding, retention strategies, and succession planning.
  
  
  • Initiates and processes personnel-related actions, including status changes, transfers, promotions, disciplinary actions, and employment separations in accordance with organizational policies.
  
  
  • Oversees staff scheduling, timekeeping, attendance management, and staffing allocations to ensure operational coverage and efficient utilization of resources.
  
  
  • Develops, implements, and coordinates onboarding, training, and competency programs to ensure team members possess the knowledge and skills necessary to perform their roles effectively.
  
  
  • Communicates departmental, organizational, regulatory, and system-related updates to staff and ensures consistent understanding and implementation of policies, procedures, and best practices.
  
  
  • Serves as a subject matter expert and resource for staff, providing guidance and support for technical, operational, coding, reimbursement, and procedural issues.
  
  
  • Promotes a culture of continuous improvement by identifying opportunities to enhance operational performance, employee engagement, quality outcomes, and reimbursement results.
  
  
  • Effectively manages multiple priorities and responsibilities with a high degree of accuracy, attention to detail, and compliance with departmental and organizational standards.
  
  


• Operational Management & Excellence:
  
  
  
  • Develops, implements, and maintains departmental policies, procedures, workflows, internal controls, and automation strategies that promote operational efficiency, regulatory compliance, and optimal service delivery.
  
  
  • Evaluates operational processes and performance metrics to identify improvement opportunities, recommend policy and workflow enhancements, and drive sustainable revenue cycle outcomes.
  
  
  • Assists in the development, implementation, and execution of departmental business plans, ensuring resources, priorities, and operational activities align with organizational goals and strategic objectives.
  
  
  • Oversees insurance and government accounts receivable operations, including claims billing, coding-related claim edits, denial management, appeals, underpayment recovery, and reimbursement optimization activities.
  
  
  • Directs complex denial management efforts involving coding, authorization, medical necessity, documentation, and payer policy denials. Analyzes denial trends and implements corrective action plans to reduce preventable denials and improve financial performance.
  
  
  • Serves as the departmental subject matter expert for professional coding, reimbursement methodologies, payer policies, claim-edit resolution, modifier application, and documentation requirements.
  
  
  • Collaborates with Coding, Compliance, Patient Access, Revenue Integrity, Clinical Operations, and Information Technology teams to identify root causes of denials, billing inaccuracies, and workflow inefficiencies, and implement effective, sustainable solutions.
  
  
  • Monitors payer-specific performance, reimbursement trends, coding updates, regulatory requirements, and industry best practices to ensure accurate claim adjudication, regulatory compliance, and maximized revenue recovery.
  
  
  • Develops and oversees appeal strategies for complex and high-dollar denials, ensuring timely resolution and optimization of reimbursement opportunities.
  
  
  • Resolves escalated operational, reimbursement, payer, and customer service issues in a timely, professional, and results-oriented manner.
  
  
  • Serves as a liaison across interdisciplinary teams and external stakeholders to promote collaboration, resolve operational challenges, and support organizational objectives.
  
  
  • Leads initiatives designed to enhance the patient and family financial experience through process improvements, service excellence, and effective communication.
  
  
  • Ensures compliance with organizational policies, quality standards, accreditation requirements, payer regulations, and applicable federal and state laws governing healthcare reimbursement.
  
  
  • Supports the department manager in executing strategic initiatives, operational priorities, and performance improvement activities to achieve departmental goals.
  
  
  • Identifies, recommends, and effectively utilizes resources required to meet operational objectives, including contributing to budget planning, staffing needs, and expense management.
  
  
  • Partners with Information Technology and vendors to evaluate, implement, test, and optimize electronic health record (EHR), clearinghouse, and revenue cycle system enhancements that improve operational performance and reimbursement outcomes.
  
  
  • Maintains advanced knowledge of healthcare revenue cycle operations, CMS, Medicaid, HIPAA, EDI transactions, payer contracts, reimbursement regulations, and industry trends through ongoing professional development and active participation in professional organizations such as HFMA, AAPC, AHIMA, and other relevant associations.
  
  
  • Promotes a culture of continuous improvement, accountability, innovation, and operational excellence through data-driven decision-making and performance monitoring.
  
  


• System Integration & Testing:
  
  
  
  • Leads the evaluation, analysis, and optimization of revenue cycle systems to identify opportunities for automation, workflow efficiency, billing accuracy, and reimbursement improvement.
  
  
  • Analyzes operational and system-related business needs and recommends enhancements to Epic Professional Billing (PB), clearinghouse applications, and related revenue cycle technologies to support organizational objectives.
  
  
  • Identifies and leads interdisciplinary initiatives across the organization to improve billing workflows, strengthen claim accuracy, prevent denials, and enhance overall revenue cycle performance.
  
  
  • Serves as the departmental subject matter expert for Epic Professional Billing and associated revenue cycle systems, providing operational oversight and guidance on system functionality, billing workflows, and reimbursement impacts.
  
  
  • Collaborates with Information Technology, Revenue Integrity, Coding, Compliance, and operational stakeholders to define system requirements, validate enhancements, and ensure alignment with regulatory standards and revenue cycle best practices.
  
  
  • Coordinates, oversees, and provides final operational approval for testing of new system builds, upgrades, enhancements, and workflow changes to ensure successful implementation and minimal disruption to operations.
  
  
  • Evaluates and optimizes claim edit work queues, billing rules, charge review processes, and denial prevention edits to ensure compliance with coding standards, payer requirements, and reimbursement guidelines.
  
  
  • Partners with Revenue Integrity, Coding, and Information Technology teams to design, implement, and validate system enhancements that improve claim quality, reduce manual intervention, minimize denials, and increase automation.
  
  
  • Monitors system performance, operational outcomes, and reimbursement trends to identify opportunities for process improvement, workflow redesign, and technology-driven solutions.
  
  
  • Supports the implementation of new regulatory requirements, coding updates, payer policy changes, and organizational initiatives by ensuring appropriate system configuration, testing, training, and operational readiness.
  
  
  • Provides leadership, training, and ongoing support related to revenue cycle technologies, system enhancements, workflow modifications, and process improvement initiatives.
  
  

Education Qualifications

• Bachelor's Degree from an accredited college or university in healthcare administration, business administration, finance, or related field Required or


• Equivalent relevant work experience may be substituted for education Required

Experience Qualifications

• Minimum 5 years' experience in healthcare revenue cycle operations including insurance billing, accounts receivable follow-up, denial management, appeals, reimbursement analysis, and claim resolution Required and


• Minimum 3 years' experience managing complex payer denials, including coding-related denials, medical necessity denials, authorization denials, underpayments, and appeal processes. Required and


• One year lead or supervisory experience Preferred and


• Demonstrated experience interpreting and applying CPT, HCPCS, ICD-10-CM, and payer-specific billing and reimbursement guidelines Preferred

Skills and Abilities

• Knowledge of Revenue Cycle Operations, third party reimbursement, local, state, federal regulations and medical terminology. This includes all aspects of payer relations, claims adjudication, contractual claims process and general reimbursement procedures including knowledge of CPT, HCPCS and revenue codes and their effect on hospital reimbursement. Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental program regulations.


• Strong, positive customer relations and the ability to communicate effectively both verbally and in writing


• Excellent problem solving skills


• Fosters teamwork and collaboration


• Effective conflict resolution; active listening skills


• Good Microsoft Word, Excel and PowerPoint


• Strong understanding of denial management, appeals processes, claims adjudication, payer reimbursement methodologies, and coding compliance. Knowledge of CPT, HCPCS, ICD-10-CM, modifiers, revenue codes, and payer billing requirements. Ability to analyze denial trends, identify root causes, and implement process improvements to reduce denials and improve reimbursement outcomes.

Licenses and Certifications

• Certified Professional Coder AAPC Certification Required and


• Certified Coding Specialist Preferred or


• Certified Professional Biller Preferred

Children’s is the very best for kids and the very best
for your career! At Children’s, we put YOU first so together, we can
improve the life of every child!