Overview:
Work remotely while using your denial management expertise to make a direct impact on healthcare operations.
Work Style: Remote
Location Requirement: Must reside in Florida or Georgia
FTE: Full-Time (1.0 FTE)
Responsible for reviewing technical denial claims, submitting reconsiderations or appeals. Responsible to optimize the financial outcomes of revenue cycle through maintaining a low denial rate and high reimbursement rate at an enterprise level for UF Health.
Initiates a root cause analysis of denied payment through comprehensive means including, but not limited to, research of patient stays and treatment, review of payer contracts, analysis of historical denials, appeals and their outcomes, and emerging trends in payer practices and requirements.
Works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence. Working in conjunction with the Enterprise Technical Denial Assistance Manager and Enterprise Sr. Denial Manager, maintains a strong working relationship with the Enterprise Managed Care Department to escalate and resolve atypical denial issues.
Knowledgeable of state and federal laws that relate to contracts and to the appeals process. Considered a technical denial expert in denial management and ensures all denied claims are accurately worked from a technical/billing perspective.
Working in collaboration with the different Revenue Cycle departments throughout the enterprise to establish best practice solutions to maximize reimbursement and minimize organizational write-offs.
Responsibilities:
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Identify, prioritize, and resolve denied claims, including initiating timely appeals and reconsiderations
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Interpret and apply payer contract terms to ensure accurate claim resolution and reimbursement
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Conduct internal and external correspondence clearly, professionally, and in compliance with organizational standards
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Review and take appropriate action on EOBs, denial letters, appeal determinations, and documentation requests in a timely manner
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Meet productivity and accuracy standards, including working an average of 60 accounts per day with a 98% accuracy rate
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Manage and work multiple payer workqueues, including Medicare, Medicaid, government, commercial, and Medicare Advantage plans
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Research and resolve denials related to eligibility, registration, billing errors, missing information, and documentation requests
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Initiate and follow up on appeals to prevent timely filing denials and ensure optimal reimbursement outcomes
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Evaluate accounts and drive resolution using tools such as remittance advice, denial codes, and payer communications
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Identify payer-specific denial trends and escalate findings to leadership with actionable insights for root cause analysis
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Collaborate with revenue cycle teams across the enterprise to recommend process improvements and prevent future denials
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Review payer policies and communications to identify risks to reimbursement and stay current on regulatory and industry best practices
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Proactively identify and resolve at-risk A/R to minimize revenue loss and ensure compliance with contractual deadlines
Qualifications:
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High School Diploma or GED required
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Minimum of four (4) years of experience in billing, insurance follow-up, collections, or denial management within a hospital or clinical setting
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Associate’s degree or higher in a health or business-related field
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Experience in coding, medical record review, auditing, or insurance-related functions
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Experience supporting data governance and security policies
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Strong skills in report and dashboard development
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Ability to monitor BI tools and recommend process improvements
