Denial Recovery Analyst | Enterprise Denials | Remote (must reside in FL, GA, PA, NC, SC, TN or TX)

Responsible for reviewing technical denial claims and submitting reconsiderations or appeals. Optimizes financial outcomes within the revenue cycle by maintaining low denial rates and maximizing reimbursement 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, complaints, and correspondence. Collaborates with Enterprise Technical Denial Assistance leadership and Managed Care to escalate and resolve complex denial issues. Ensures compliance with state and federal regulations related to contracts and appeals.

Serves as a subject matter expert in denial management, ensuring accurate resolution of denied claims from a technical and billing perspective. Partners with revenue cycle departments across the enterprise to implement best practices that improve reimbursement and reduce organizational write-offs.

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 accuracy standards, including working an average of 60 accounts per day with 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, and documentation requests
• Initiate and follow up on appeals to prevent timely filing denials and ensure optimal reimbursement outcomes
• Evaluate accounts and drive resolution using tools such as remittance advice, denial codes, and payer communications
• Identify payer-specific denial trends and escalate findings to leadership with actionable insights for root cause analysis
• Collaborate with revenue cycle teams across the enterprise to recommend process improvements and prevent future denials
• Review payer policies and communications to identify risks to reimbursement and stay current on regulatory and industry best practices
• Proactively identify and resolve at-risk A/R to minimize revenue loss and ensure compliance with contractual deadlines

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