Denial Recovery & Appeals Specialist

Coral West Community Hospital; Miami (FL); Hybrid; USD 42,000 - 62,000; Full time

Job summary

Coral West Community Hospital in Miami is seeking a Denial Recovery Specialist to resolve denied and underpaid medical claims. You will act as subject matter expert to identify root causes and drive timely resolutions.

You will analyze denials, develop corrective action plans, and coordinate with payers and management. The role requires strong knowledge of ICD-10, CPT, HCPCS, and Medicare/Medicaid guidelines.

Qualifications

• More than 2 years of claims processing or claims auditing experience.
• Knowledge of billing guidelines and ICD-10, CPT, and HCPCS coding.
• Experience with Medicare and Medicaid billing guidelines and rules, insurance reimbursement methods, and the claims appeal process.
• Working knowledge of insurance explanation of benefits and denial codes.
• Understanding of managed care contracts and capitation payments.
• Computer proficiency in Word, Excel, Outlook, along with general knowledge of internet research and medical billing systems.
• Personal effectiveness and credibility.
• Confidentiality.

Responsibilities

• Identify, analyze, and research frequent root causes of denials and underpayments.
• Develop corrective action plans for resolution of denials.
• Prioritize activities to work denials and underpayments in a timely manner to alleviate untimely files.
• Communicate with management regarding any issues or changes in the billing system and/or payers.
• Document all denial and underpayment activity in the patient accounting system.
• Assist with monthly denial reporting.
• Create and process timely appeals in order to overturn denials.
• Comply with all policies, procedures, and related protocols as established by the organization.
• Participate in the continuous quality improvement process.
• Perform all other duties as assigned or required.

Skills

Claims processing

Claims auditing

Billing guidelines

ICD-10 coding

CPT coding

HCPCS coding

Medicare billing

Medicaid billing

EOB knowledge

Denial resolution

Tools

Word

Excel

Outlook

Job description

Coral West Community Hospital in Miami is seeking a Denial Recovery Specialist to resolve denied and underpaid medical claims. You will act as subject matter expert to identify root causes and drive timely resolutions.

You will analyze denials, develop corrective action plans, and coordinate with payers and management. The role requires strong knowledge of ICD-10, CPT, HCPCS, and Medicare/Medicaid guidelines.