Director, Denials Prevention & Performance Improvement

Director, Denials Prevention & Performance Improvement

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.

The Director, Denials Prevention & Performance Improvement leads the enterprise-wide strategy for reducing denials, improving upstream workflows, and driving systemic performance improvement across all Revenue Cycle functions. This role oversees denial analytics, cross-functional remediation efforts, clinical and operational partnerships, and digital enablement strategies to strengthen financial outcomes and reduce revenue leakage. The Director aligns facility-specific needs with enterprise priorities and ensures visibility, accountability, and measurable operational improvement across Beth Israel Lahey Health (BILH).

Essential Duties & Responsibilities including but not limited to:

• Lead the development and execution of an enterprise denials prevention strategy across hospital and professional billing environments.
• Analyze clinical, technical, and payer-related denial trends to identify root causes and drive upstream corrective actions.
• Partner with Clinical Revenue Cycle, Physician Advisors, and clinical departments to address documentation, medical necessity, and coding-related denial drivers.
• Collaborate with Access & Experience to mitigate front-end authorization and eligibility denials.
• Coordinate with Patient Financial Services to understand denial patterns, payer-specific issues, and system-level trends.
• Establish enterprise standards for denial categorization, tracking, reporting, and root cause identification.
• Lead structured performance improvement initiatives using disciplined problem-solving methodologies.
• Oversee Revenue Cycle digital and automation strategy to enhance work queues, workflows, and system configuration.
• Deploy technology-enabled solutions (automation, reporting enhancements, workflow redesign) to strengthen productivity and reduce manual effort.
• Monitor initiative ROI and ensure measurable improvements in denial rate, net revenue yield, and AR performance.
• Partner with Revenue Cycle Business Partners and PFS Denial Recovery lead to prioritize facility-specific interventions based on performance trends.
• Collaborate with Enabling Services (Reporting & Analytics) to enhance dashboards and KPI visibility for operational and clinical leaders.
• Maintain current knowledge of regulatory requirements, payer rules, industry trends, and emerging technologies to inform strategic planning.
• Elevate systemic risks and opportunities to Revenue Cycle and Executive Financial Leadership.

Minimum Qualifications:

• Bachelor's degree required; Master's degree preferred.

Experience:

• 5-8 years' demonstrated experience leading Revenue Cycle performance improvement initiatives in a complex health system.

Skills, Knowledge & Abilities:

• Deep knowledge of hospital and professional billing workflows and denial prevention best practices.
• Strong analytical abilities with capacity to synthesize complex data into actionable strategies.
• Ability to influence physicians, clinical leaders, and operational stakeholders without direct authority.
• Executive presence and strong communication skills for presenting complex issues to senior leadership.
• Strong understanding of clinical, technical, and payer-related denial drivers and upstream workflow dependencies.

Preferred Qualifications & Skills:

• Working knowledge of Epic Revenue Cycle applications and reporting infrastructure preferred.

Key Business Relationships (Title and Purpose):

• Enabling Services Lead Align on enterprise priorities and improvement roadmap.
• Revenue Cycle Business Partners Collaborate on facility-specific denial trends and targeted interventions.
• Physician Advisors & Clinical Leaders Improve documentation integrity and medical necessity compliance.
• Revenue Cycle Leaders Partner to coordinate front-end, clinical, and back-end denial prevention.

Physical Requirements & Environment:

• Standard office environment; extensive computer use; travel between sites as needed.

Pay Range:

$165,000.00 USD - $180,000.00 USD

The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled