Denials Management 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

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

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

900 HOPE WAY

City

ALTAMONTE SPRINGS

State

Florida

Postal Code

32714

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

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/

Pay Range

$19.96 - $37.11

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