Denials & Appeals Specialist – Revenue Cycle

Hamilton County Hospital District; États-Unis; Sur place; USD 55 000 - 75 000; Plein temps

Résumé du poste

Hamilton County Hospital District is seeking a Denials and Appeals Specialist to review, resolve, and track assigned claim denials and appeals across commercial and government payers. You will identify recurring denial causes, coordinate prevention efforts with revenue cycle teams, and ensure accurate reporting to leadership.

Minimum one year in hospital revenue cycle with denials required; associates preferred.

Qualifications

• High school graduate or equivalent required; associate degree or coursework in healthcare administration, business, medical billing or related field preferred.
• Knowledge of hospital billing, payer requirements, EOBs and electronic remittance advice, claim adjustment and remark codes, and appeal processes.
• Proficiency with Excel, electronic health records, clearinghouse work queues, and payer portals. Ability to analyze trends, organize deadlines, document findings, and communicate effectively with clinical and administrative teams.

Responsabilités

• Review denied claims and appeals and track resolution; identify recurring denial causes and coordinate prevention across the revenue cycle.
• Review assigned payment variances against payer contract terms and reimbursement methodologies, pursue recovery, and communicate unresolved discrepancies to leadership.
• Maintain accurate work queues and reports to support reimbursement, timely filing, and departmental improvement.
• Assignments may include inpatient, swing bed, surgery, outpatient, ED, rural health clinic, and professional claims across commercial and government payers; leadership defines payer/service assignments.

Connaissances

Hospital billing

Payer requirements

Remittance advice

Claim adjustment codes

Appeals process

Excel

EHR systems

Clearinghouse software

Payer portals

Trend analysis

Deadline management

Cross-functional comms

Formation

High school diploma

Associate degree in healthcare administration

Outils

Clearinghouse software

Payer portals

Description du poste

Hamilton County Hospital District is seeking a Denials and Appeals Specialist to review, resolve, and track assigned claim denials and appeals across commercial and government payers. You will identify recurring denial causes, coordinate prevention efforts with revenue cycle teams, and ensure accurate reporting to leadership.

Minimum one year in hospital revenue cycle with denials required; associates preferred.