Denials & Appeals Billing Supervisor; Lab Billing XP req

Denials & Appeals Medical Laboratory Billing Supervisor

Rocky Mountain Laboratories – Remote in AZ, CO, , NV, UT, FL, or TX

Rocky Mountain Laboratories is a leading clinical and molecular diagnostics laboratory providing comprehensive testing and billing services to healthcare providers nationwide. We are dedicated to delivering accurate and timely diagnostic results through cutting‑edge technology, automation, and a patient‑focused approach.

The Denials & Appeals Billing Supervisor oversees daily denial management and appeals operations within the revenue cycle, with a specialized focus on payer denials, underpayments, appeal submissions, follow‑up, and root cause analysis. This role is specialized and focused on denials and appeals, rather than general billing or claim submission, and is responsible for driving timely resolution, revenue recovery, and denial prevention.

This position reports directly to the Revenue Cycle Manager and provides functional leadership to denials and appeals staff while serving as a subject‑matter expert in payer policy interpretation, appeal strategy, and denial trend analysis.

Denial Management, Appeals Management, Underpayments, Advanced

MD (AMD), Medical Billing, Laboratory Billing, A/R Follow‑Up, Medical Necessity Denials, Payer Appeals, Revenue Cycle

• Review, prioritization, and resolution of payer denials and underpayments
• Preparation, submission, and tracking of first‑level, second‑level, and advanced appeals, including payer reconsiderations
• Follow‑up on appealed claims to ensure timely adjudication and payment
• Identification and correction of claim issues prior to resubmission
• Manage and prioritize denials and appeals work queues to meet turnaround, accuracy, and recovery benchmarks
• Serve as the primary escalation point for complex, high‑dollar, or recurring denials
• Analyze denial trends and perform root cause analysis by payer, denial reason, and error type
• Partner with front‑end, coding, billing, and payment posting teams to reduce preventable denials
• Ensure appeals are compliant with payer policies, timelines, and documentation requirements
• Interpret payer policies, LCDs/NCDs, and medical necessity guidelines as they relate to laboratory billing
• Develop and maintain SOPs, workflows, and reference documentation for denials and appeals processes
• Provide training, guidance, and performance feedback to denials and appeals staff
• Assist with onboarding and training new team members
• Monitor and report on denial rates, appeal success rates, recovery trends, and repeat denial patterns
• Collaborate with Revenue Cycle leadership and IT on workflow improvements, automation, and reporting enhancements
• Participate in system upgrades, enhancements, and user acceptance testing as needed
• Ensure compliance with payer rules, audit standards, and internal controls
• Perform additional supervisory or operational duties as assigned

• Minimum 3–4 years of hands‑on denials and appeals experience, with direct ownership of appeal submissions and follow‑up
• Laboratory billing experience (toxicology, molecular, PCR, or similar)
• Direct experience resolving medical necessity, bundling, frequency, coverage, eligibility, and timely filing denials
• Experience managing payer underpayments and misprocessed claims
• Strong understanding of payer policies, appeal timelines, and documentation requirements
• Demonstrated experience performing denial trend analysis and recommending corrective actions
• Proficiency with billing systems, clearinghouses, and payer portals
• Strong attention to detail, organization, and problem‑solving skills
• Ability to work independently and lead workflows in a fully remote environment

• Advanced
  
  MD (AMD) experience within denials or A/R workflows
• Experience developing or improving denial prevention strategies
• Familiarity with payer‑specific escalation and appeal processes
• Experience collaborating with front‑end billing, coding, or claim submission teams
• Prior experience mentoring or informally leading denials or A/R staff
• Experience supporting automation or reporting related to denial tracking and recovery

• CPC or…