Denial Recovery Analyst | Enterprise Denials - Durbin Park
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AI Summary
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 and submitting reconsiderations and appeals to ensure accurate and timely reimbursement. Optimizes financial performance within the revenue cycle by maintaining low denial rates and maximizing recovery across the enterprise.
Conducts root cause analysis of denied payments through comprehensive review of patient encounters, payer contracts, historical denial trends, and appeal outcomes. Maintains strong relationships with third-party payers, responding to inquiries, disputes, and correspondence.
Collaborates with Enterprise Technical Denial Assistance leadership and Managed Care to escalate and resolve complex denial issues while ensuring compliance with state and federal regulations. Serves as a subject matter expert in denial management, partnering with revenue cycle teams to implement best practices that improve reimbursement and reduce organizational write-offs.
Responsibilities
Key Responsibilities
- Identify, prioritize, and resolve denied claims, including initiating timely appeals and reconsiderations.
- Interpret and apply payer contract terms to ensure accurate claim resolution and reimbursement.
- Conduct internal and external correspondence clearly, professionally, and in compliance with organizational standards.
- Review and take appropriate action on EOBs, denial letters, appeal determinations, and documentation requests in a timely manner.
- Meet productivity and quality standards, including managing an average of 60 accounts per day while maintaining a 98% accuracy rate.
- Manage and work multiple payer workqueues, including Medicare, Medicaid, government, commercial, and Medicare Advantage plans.
- Research and resolve denials related to eligibility, registration, billing errors, missing information, authorizations, and documentation requests.
- Initiate, track, and follow up on appeals to prevent timely filing denials and maximize reimbursement opportunities.
- Evaluate accounts and drive resolution using remittance advice, denial codes, payer portals, and payer communications.
- Identify payer-specific denial trends and escalate findings to leadership with actionable recommendations for root cause analysis.
- Collaborate with coding, billing, clinical, and revenue cycle teams to improve workflows and reduce future denials.
- Review payer policies, reimbursement guidelines, and communications to remain current on regulatory and industry changes.
- Proactively identify and resolve at-risk accounts receivable to minimize revenue loss and ensure compliance with contractual deadlines.
- Maintain detailed account documentation and ensure all actions are accurately recorded within designated systems.
- Support organizational revenue integrity initiatives through denial prevention, reimbursement optimization, and process improvement efforts.
- Serve as a subject matter resource for denial resolution, payer requirements, and reimbursement best practices.
Qualifications
Minimum Qualifications
• High School Diploma or GED required
• Minimum of four (4) years of experience in billing, insurance follow-up, collections, or denial management within a hospital or clinical setting
Preferred Qualifications
• Associate’s degree or higher in a health or business-related field
• Experience in coding, medical record review, auditing, or insurance-related functions
• Experience supporting data governance and security policies
• Strong skills in report and dashboard development
• Ability to monitor BI tools and recommend process improvements
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