Denials & Appeals Specialist

Brown Medicine; Cranston (RI); On-site; USD 32,000 - 53,000; Full time

Job summary

Brown University Health seeks a Denials Management Specialist to maximize reimbursement from contracted payers by analyzing denials, tracking trends, and supporting strategic initiatives related to denials.

You will execute appeals with third-party payers, review monthly denial reports, and maintain strong relationships with hospital departments to obtain necessary information for successful reversals.

Qualifications

• Associate’s degree or equivalent experience in accounting or related area.
• 3–5 years’ experience in hospital patient accounting with knowledge of claims administration.
• Familiarity with ICD-9/10, CPT-4 coding, UB04, HCFA 1500.
• Ability to perform financial analysis and identify denial trends.

Responsibilities

• Evaluate denied accounts for review and assign to appropriate departments.
• Identify repetitive denial issues and propose preventative solutions.
• Run denial reports and track accounts to ensure timely processing.
• Maintain documentation of appeals and responses to payer denials.
• Communicate with hospital departments and physician offices to obtain required information for appeals.
• Stay updated on state and federal regulations, payer contracts and policies.

Skills

Financial analysis

Claims administration

ICD-9/10 knowledge

HB/HB coding guidelines knowledge

Education

Associate’s degree in accounting, business office practices, computer science or related area

Tools

LifeChart

UB04

Microsoft Teams

Job description

Brown University Health seeks a Denials Management Specialist to maximize reimbursement from contracted payers by analyzing denials, tracking trends, and supporting strategic initiatives related to denials.

You will execute appeals with third-party payers, review monthly denial reports, and maintain strong relationships with hospital departments to obtain necessary information for successful reversals.