Denials Management Specialist

adventhealth; Biñan; On-site; PHP 3,484,353,000 - 6,480,230,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Life Insurance

Disability Insurance

PTO from Day One

403-B Retirement Plan

Parental Leave

Career Development

Whole Person Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth is seeking a Denials Management Specialist to review and appeal denials across service lines, researching histories and payer policies to determine optimal strategies. You will collaborate with multiple departments to gather documentation and provide actionable remediation insights.

This full-time, day-shift role in Florida requires proficiency in CPT/HCPCS/ICD codes, EMR navigation, and strong communication skills to educate stakeholders and improve revenue cycle outcomes.

Qualifications

• Understanding of revenue cycle processes including charge capture and billing regulations
• Knowledge of CPT, HCPCS, ICD codes, UB-04 Revenue Codes, and modifiers
• Ability to navigate the electronic medical record and correlate services to charges
• Strong critical thinking and problem-solving skills with ability to multi-task and reprioritize in a fast-paced environment
• Self-starter with ability to work independently with limited day-to-day oversight
• Strong written communication and grammatical skills
• Technical proficiency within Patient Accounting systems and applicable vendor technologies for account research
• Proficiency in Microsoft Suite applications, specifically Excel, Word, and Outlook
• Ability to navigate payer websites and portals for research purposes
• Proficiency with Epic EHR system
• Comfort with interpreting payer contractual language
• Experience with medical billing and remittance forms including 835 and 837 files, UB-04 and CMS-1500 forms

Responsibilities

• Reviews and appeals denials across all service lines system-wide
• Researches account histories, patient encounters, payer portals, and payment records to determine appropriate appeal strategies
• Evaluates denial types including charge audit, charge capture, authorization, timely filing, and payer policy denials
• Recommends charge corrections and prepares accounts for rebilling as appropriate
• Collaborates with pre-access, patient financial services, revenue integrity, utilization management, and clinical departments to gather supporting documentation
• Provides reports, education, and training on denial trends and recommended remediation strategies
• Educates stakeholders on proper documentation, payer processes, and policies with a denial prevention focus
• Drafts and submits written and verbal appeals using clear, concise terminology
• Researches root causes, collects supporting documentation, and adjusts accounts based on internal and external findings
• Utilizes multiple IT systems to compile comprehensive clinical and financial information for appeals
• Escalates identified claim issues and trends to appropriate leadership or payer contacts
• Performs other duties as assigned

Skills

Revenue cycle

CPT/HCPCS/ICD

EMR navigation

Critical thinking

Independent work

Written communication

MS Office

Payer portals

Epic EHR

Contract language

Education

High School Diploma or equivalent

Bachelor’s degree preferred

Tools

Epic EHR

Microsoft Excel

Job description

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

2600 LUCIEN WAY

City:

MAITLAND

State:

Florida

Postal Code:

32751

Job Description:

• Reviews and appeals denials across all service lines system-wide

• Researches account histories, patient encounters, payer portals, and payment records to determine appropriate appeal strategies

• Evaluates denial types including charge audit, charge capture, authorization, timely filing, and payer policy denials

• Recommends charge corrections and prepares accounts for rebilling as appropriate

• Collaborates with pre-access, patient financial services, revenue integrity, utilization management, and clinical departments to gather supporting documentation

• Provides reports, education, and training on denial trends and recommended remediation strategies

• Educates stakeholders on proper documentation, payer processes, and policies with a denial prevention focus

• Drafts and submits written and verbal appeals using clear, concise terminology

• Researches root causes, collects supporting documentation, and adjusts accounts based on internal and external findings

• Utilizes multiple IT systems to compile comprehensive clinical and financial information for appeals

• Escalates identified claim issues and trends to appropriate leadership or payer contacts

• Performs other duties as assigned

Knowledge, Skills, and Abilities:

• Understanding of revenue cycle processes including charge capture and billing regulations [Required]

• Knowledge of CPT, HCPCS, ICD codes, UB-04 Revenue Codes, and modifiers [Required]

• Ability to navigate the electronic medical record and correlate services to charges [Required]

• Strong critical thinking and problem-solving skills with ability to multi-task and reprioritize in a fast-paced environment [Required]

• Self-starter with ability to work independently with limited day-to-day oversight [Required]

• Strong written communication and grammatical skills [Required]

• Technical proficiency within Patient Accounting systems and applicable vendor technologies for account research [Required]

• Proficiency in Microsoft Suite applications, specifically Excel, Word, and Outlook [Required]

• Ability to navigate payer websites and portals for research purposes [Required]

• Proficiency with Epic EHR system [Preferred]

• Comfort with interpreting payer contractual language [Preferred]

• Experience with medical billing and remittance forms including 835 and 837 files, UB-04 and CMS-1500 forms [Preferred]

Education:

• High School Grad or Equiv [Required]

• Bachelors [Preferred]

Work Experience:

• 3+ years of denials management or revenue cycle experience [Required]

• 5+ years of denials management or revenue cycle experience [Preferred]

Licenses and Certifications:

• Certified Revenue Cycle Rep (CRCR) [Preferred]

Physical Requirements:

Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

$19.76 - $36.75

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.