Denials Management & Appeals Specialist

AdventHealth; Florida; On-site; USD 28,000 - 51,000; Full time

Benefits offered by this job

Benefits from Day One: Medical, Dental

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

Pet Benefits

Job summary

AdventHealth in Florida is seeking a Denials Management Specialist to review and appeal insurance denials across service lines. You will research payer policies, evaluate denial types, and prepare rebilling with supporting documentation to optimize revenue.

Collaboration with clinical and administrative teams is essential for remediation and prevention. The role requires several years of denials/revenue cycle experience, strong analytical skills, and proficiency with CPT/ICD codes, payer

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 the ability to multi-task 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 vendor technologies for account research.
• Proficiency with Microsoft Excel, Word, and Outlook.
• Ability to navigate payer websites and portals for research purposes.
• Epic EHR system proficiency is preferred.

Responsibilities

• Reviews and appeals denials across all service lines system-wide.
• Researches account histories, payer portals, and payment records to determine 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 various departments to gather supporting documentation.
• Provides reports, education, and training on denial trends and remediation strategies.
• Educates stakeholders on documentation, payer processes, and denial prevention.
• Drafts and submits written and verbal appeals with clear terminology.
• Researches root causes and adjusts accounts based on findings.
• Uses multiple IT systems to compile clinical and financial information for appeals.
• Escalates identified claim issues to leadership or payer contacts.

Skills

Revenue cycle

Charge capture

Billing regulations

CPT/HCPCS/ICD

EMR navigation

Critical thinking

Independent work

Excel

Payer portals

Epic EHR

Education

High School Grad or Equiv

Bachelors

Tools

Epic EHR

Microsoft Office

Job description

AdventHealth in Florida is seeking a Denials Management Specialist to review and appeal insurance denials across service lines. You will research payer policies, evaluate denial types, and prepare rebilling with supporting documentation to optimize revenue.

Collaboration with clinical and administrative teams is essential for remediation and prevention. The role requires several years of denials/revenue cycle experience, strong analytical skills, and proficiency with CPT/ICD codes, payer