Enterprise Denials Program Manager

#CA-KN

The Enterprise Denials Program Manager will enhance the current denials management process to reduce denials. Primary function to own payor-specific denial root cause analysis and workflow improvement response. A technical leader with a high degree of knowledge in the broad field and recognized expertise in specific areas; problem-solving frequently requires analysis of unique issues/problems without precedent and structure. Works with internal and external departments to formulate strategies, administer policies, processes, and resources, functions with a high degree of autonomy. Involves revenue cycle functions for the healthcare enterprise, including system billing, reporting, and support. Ensures account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services. Impacts processes to include authorization, registration, charge capture, coding, insurance identification, data entry, billing, contract management, payment posting, refund processing, and collections. Provides expert analysis and reporting of contract payer performance to include payment trends, denials, delinquencies, and payment variances from expected reimbursement; identification and tracking of issues related to denials for feedback to Denial Management to maximize revenue and increase efficiency, highly skilled in Epic Reporting Workbench, Clarity Reporting and comprehensive AR reporting as well as monthly trend reports of manual write-offs. This position's primary functions are analysis, system/process development, problem resolution, and workflow oversight. This position requires an expert level of operations and contract knowledge, a high level of independence and creativity, advanced analytical skills and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems in revenue cycle program areas, to identify weaknesses and develop innovative solutions and process improvements, sound judgment, as well as organizational and priority setting abilities. This position also serves as a backup for the department manager for operations and technical issues.

Apply By Date: 1/22/2026 at 11:59 pm - Interviews and recruiting process may occur at any time

Minimum Qualifications - For full consideration, applicants are encouraged to upload license and/or certification if required of the position

• Bachelor's Degree in Business, Healthcare Administration, Health Information Management, or related field or equivalent combination of education and experience within a healthcare facility.
• Extensive experience in revenue cycle operations, denial management, payer policy, or related healthcare domains.
• Extensive experience in supervising and managing the daily activities of a team, ensuring efficient workflows, effective reporting, and comprehensive analytics.
• Experience recruiting, training, and mentoring denial analyst(s), ensuring they have the skills and tools needed to succeed.
• Experience developing and maintaining procedures for tracking, appealing, and resolving denials to improve reimbursement rates.
• The Denial Management Program Manager leads the UCDH's efforts to identify, analyze, and resolve claim denials, ensuring appropriate reimbursement and financial performance. This role involves designing and implementing denial prevention strategies, managing a specialized team, and collaborating with internal and external stakeholders to improve revenue cycle efficiency. The ideal candidate possesses a strong understanding of denial management processes, healthcare billing, and payer requirements.
• In-depth understanding of the issues, processes, reporting instruments, metrics, dashboard design, and other tools and techniques involved with measuring and analyzing the revenue cycle.
• Ability to interpret a large volume of data and report it in a concise, meaningful manner.
• Excellent leadership and team management skills to provide guidance and oversight to denials analyst(s)
• Knowledge of hospital billing and reimbursement procedures for Commercial/Managed Care and Government payers and the ability to recognize when policies are not being followed. Including experience with contracts pertaining to the division of financial responsibility and evaluating billing and reimbursement terms.
• Knowledge of professional billing and reimbursement procedures for Commercial/Managed Care and Government payers and the ability to recognize when policies are not being followed. Including experience with contracts pertaining to the division of financial responsibility and evaluating billing and reimbursement terms.
• Proficiency in Epic denial reporting and workflows
• Detail-oriented and organized, with the ability to manage multiple priorities and effective communicate findings in-depth knowledge of the practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.
• Knowledge of healthcare compliance regulations and payer guidelines related to denials.
• Strong ability to advise management, serving as a technical expert, providing proposals for improvement and guidance on regulatory changes and industry trends and developments in revenue cycle management.
• Technical knowledge of all licensed health care service plans, including State and Federal plans, billing policies and procedures, and the ability to recognize when they are not being followed.
• In-depth knowledge of medical billing, coding (CPT, ICD-10, and HCPCS), and payer guidelines.
• Advanced organizational and project management skills and ability to lead a team, prioritize tasks, and see projects through from inception to completion on schedule.
• Ability to react with flexibility and patience and maintain efficiency and accuracy under sustained and immediate pressure created by a heavy workload, frequent interruptions, and multiple, sometimes competing, requests.
• Advanced communications skills can interpret and convey complex clinical finance information in a clear, concise manner.
• Ability to prepare compelling and informative reports and presentations to all levels of staff and management and with the ability to work effectively across departments.
• Advanced skills in report development and various software tools specific to healthcare revenue cycle management. Skills in a common database, spreadsheet, and presentation software.
• Written skills to compose correspondence to parties outside the department and sufficiently communicate to other units within the department. Math skills to accurately add, subtract, multiply and divide.
• Develops and implements changes to systems, policies, and procedures to maintain currency in government regulations, reimbursement issues, and other matters having a potential financial impact.
• Demonstrates professionalism, tact, courtesy, and diplomacy in dealing with personnel at all levels outside the health system.
• In-depth understanding of the issues, processes, reporting instruments, metrics, dashboard design, and other tools and techniques involved with measuring and analyzing the revenue cycle.
• Ability to review the work product of departmental employees and report findings.
• Ability to work accurately and quickly under pressure to meet deadlines set by the department, government programs, or private insurance carriers.
• Advanced interpersonal skills, with the ability to collaborate effectively on highly complex projects in a team environment with various business and clinical areas.
• Knowledge and skill in working with committees and user groups to facilitate group decision-making.
• Expert knowledge of and demonstrated skill with various spreadsheet and software applications including Microsoft excel and word, Clearinghouse, Contract Management, and Patient Accounting Systems.
• Ability to work cooperatively and constructively with employees and Administration. Ability to develop evaluation criteria for improving departmental activities/programs.
• Ability to develop reports or correspondence as required.
• Ability to use billing codes, including CPT, HCPCS, Revenue Codes & ICD-9/10.
• Reading skills to understand department policy and to read correspondence from within and outside the business office. Knowledge of significant healthcare trends and issues that affect physicians, hospitals, and academic health centers.
• Knowledge of Epic billing system, fundamental functions, database structure, and reporting capabilities preferred.
• Knowledge of Huron reporting tools and reporting capabilities preferred. Knowledge of Health System methods, policies, and procedures.
• Typing skills sufficient to operate computer terminal, prepare correspondence for both within and outside the department.
• Strong analytical and problem-solving skills with the ability to interpret complex data and translate it into actionable insights.
• Demonstrated success leading cross-functional programs, initiatives, or operational improvement efforts
• Effective communicator with strong facilitation and relationship-building capabilities.
• Experience planning, managing, and evaluating denials management functional areas daily.
• Identify opportunities to improve processes and act as a catalyst for realizing these improvements.
• Good analyzing skills in identifying root causes of denial trends and recommending strategies to minimize recurring issues.

Preferred Qualifications

• Related degree preferred
• Academic institution or large integrated health system is preferred
• Experience working with interfaced/integrated multi-vendor applications preferred

Key Responsibilities

• 50% - Solution Implementation
• 45% - Solution Planning
• 5% - Special Projects/Other Duties as Assigned

Department Overview

The Enterprise Denials Prevention & Management Program provides an enterprise-wide framework to identify, prevent, and resolve denials through coordinated analytics, root cause analysis, and operational accountability. The program is housed within the Revenue Cycle division to ensure alignment with billing, coding, clinical, and payer-facing processes that directly impact reimbursement performance.

POSITION INFORMATION

• Salary or Pay Range: $9,283.33 - $19,150.00
• Salary Frequency: Monthly
• Salary Grade: Grade 26
• UC Job Title: BUS INTEL SPEC 5
• UC Job Code: 005707
• Number of Positions: 1
• Appointment Type: Staff: Career
• Percentage of Time: 100%
• Shift (Work Schedule): Monday-Friday, 8am-5pm
• Location: UCDHAS Building (HSP165)
• Union Representation: 99 - Non-Represented (PPSM)
• Benefits Eligible: Yes
• This position is hybrid (mix of on-site and remote work)

Benefits

Outstanding benefits and perks are among the many rewards of working for the University of California. UC Davis offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals. Learn more about the benefits below and eligibility rules by visiting either our handy Benefits Summary for UC Davis Health Employees or Benefits Summary for UC Davis Employees and our Benefits Page.

If you are represented by a union, benefits are negotiated between the University of California (UC) and your union and finalized in a contract. Read your bargaining unit's employment contract, stay abreast of current negotiations and learn about collective bargaining at UC: https://ucnet.universityofcalifornia.edu/labor/bargaining-units/index.html

• High quality and low-cost medical plans to choose from to fit your family's needs
• UC pays for Dental and Vision insurance premiums for you and your family
• Extensive leave benefits including Pregnancy and Parental Leave, Family & Medical Leave
• Paid Holidays annually as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
• Paid Time Off/Vacation/Sick Time as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
• Continuing Education (CE) allowance and Education Reimbursement Program as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
• Access to free professional development courses and learning opportunities for personal and professional growth
• WorkLife and Wellness programs and resources
• On-site Employee Assistance Program including access to free mental health services
• Supplemental insurance offered including additional life, short/long term disability, pet insurance and legal coverage
• Public Service Loan Forgiveness (PSFL) Qualified Employer & Student Loan Repayment Assistance Program for qualified roles
• Retirement benefit options for eligible roles including Pension and other Retirement Saving Plans. More information on our retirement benefits can be found here

Physical Demands

• Standing - Occasional Up to 3 Hours
• Walking - Occasional Up to 3 Hours
• Sitting - Frequent 3 to 6 Hours
• Lifting/Carrying 0-25 Lbs - Occasional Up to 3 Hours
• Pushing/Pulling 0-25 Lbs - Occasional Up to 3 Hours
• Bending/Stooping - Occasional Up to 3 Hours
• Squatting/Kneeling - Occasional Up to 3 Hours
• Twisting - Occasional Up to 3 Hours
• Reaching overhead - Occasional Up to 3 Hours
• Keyboard use/repetitive motion - Frequent 3 to 6 Hours

Mental Demands

• Sustained attention and concentration - Frequent 3 to 6 Hours
• Complex problem solving/reasoning - Occasional Up to 3 Hours
• Ability to organize & prioritize - Frequent 3 to 6 Hours
• Communication skills - Frequent 3 to 6 Hours
• Numerical skills - Occasional Up to 3 Hours
• Constant Interaction - Frequent 3 to 6 Hours
• Customer/Patient Contact - Frequent 3 to 6 Hours
• Multiple Concurrent Tasks - Frequent 3 to 6 Hours

Work Environment

UC Davis is a smoke and tobacco free campus effective January 1, 2014. Smoking, the use of smokeless tobacco products, and the use of unregulated nicotine products (e-cigarettes) will be strictly prohibited on any UC Davis owned or leased property, indoors and outdoors, including parking lots and residential space.

Must be able to work occasional overtime and/or flexible hours as needed. Must be self-directed and able to work autonomously in a professional and productive manner

Special Requirements - Please contact your recruiter with questions regarding which activities apply by position

• This is a critical position, as defined by UC Policy and local procedures, and as such, employment is contingent upon clearing a criminal background check(s) and may include drug screening, medical evaluation clearance and functional capacity assessment
• This position is designated as a mandated reporter under CANRA and UC policy, and employment is contingent on compliance with applicable policies, procedures and training requirements

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

A Culture of Opportunity and Belonging

At UC Davis, we're committed to solving life's most urgent challenges and building a healthier, more resilient world. We believe in growing through every challenge, continually striving to improve, and welcoming new perspectives that strengthen our community. We recognize that a vibrant and innovative organization values both individual strengths and shared purpose. The best ideas often emerge when people with different experiences come together.

As you consider joining UC Davis, we invite you to explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education. We believe you belong here. The University of California, Davis is an Equal Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

To view the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

Because we want you to feel seen and valued, our recruitment process at UC Davis supports openness and authenticity. Research shows that some individuals hesitate to apply unless they meet every qualification. You may be an excellent fit for this role-or the next one. We encourage you to apply even if your experience doesn't match every listed requirement. #YouBelongHere

To learn more about our background check program, please visit: https://hr.ucdavis.edu/departments/recruitment/ucd/selection/background-checks