Denials Management Specialist - Revenue Cycle Pro

Westchester Medical Center; Town of Mount Pleasant (NY); On-site; USD 65,000 - 90,000; Full time

Job summary

Westchester Medical Center Health Network is seeking a Denials Specialist to analyze and report on Denial Management functions across the network. The role will enable reporting to track denial write-offs to optimize net revenue recognition and ensure the integrity of the denial process.

The position requires collaboration with clinical departments, on-site staff, and Patient Access to reduce recurring denials, monitor write-off codes, and provide insights to improve billing performance.

Qualifications

• Minimum of two to three years of experience in revenue cycle, denials management or related patient financial services
• Bachelor’s degree in business, finance, or healthcare administration preferred; equivalent work experience may substitute degree requirement
• Demonstrated knowledge of healthcare management, collections management, Medicaid and Medicare
• Experience in establishing and managing claim denial activities, collection processes and methodology
• Strong organizational skills and the ability to multi-task in a fast-paced environment

Responsibilities

• Coordinates data collection, analysis, appeal, write-off and reporting activities affecting the denial process
• Communicates with clinical departments, on-site staff, and Patient Access and Mid-Cycle coordinators to reduce recurring denials
• Ensures activities meet department requirements, maximizes revenue collection, and maintains performance standards
• Works with Revenue Integrity Leaders for charge-related denials and monitors denial vendor relationships
• Monitors contract compliance and escalates to Managed Care staff as needed
• Provides denial trends to Billing Functional Leader for operational improvement
• Works with Local System Coding leaders to determine appropriate changes for DRGs, CPT, and ICD PX related denials
• Displays a client-focused service approach and quality orientation
• Under the direction of the Denial Manager, analyzes denial reports and formulates resolution strategies
• Collaborates with the Follow-up Manager to set AR management and cash collection goals
• Creates a department dashboard and ensures KPIs are met daily, weekly, and monthly
• Uses automated systems effectively to perform work assignments
• Performs related duties as assigned

Job description

Westchester Medical Center Health Network is seeking a Denials Specialist to analyze and report on Denial Management functions across the network. The role will enable reporting to track denial write-offs to optimize net revenue recognition and ensure the integrity of the denial process.

The position requires collaboration with clinical departments, on-site staff, and Patient Access to reduce recurring denials, monitor write-off codes, and provide insights to improve billing performance.