Enterprise Denial Analyst (Remote in Florida or Georgia) I Enterprise Denials I Day | Full-Time

UF Health; Gainesville (FL); Remote; USD 50,000 - 90,000; Full time

Job summary

An established industry player in healthcare is seeking an Enterprise Denial Analyst to optimize financial outcomes through effective denial management. This remote role involves reviewing technical denial claims, conducting root cause analyses, and collaborating with various departments to minimize write-offs and maximize reimbursements. The ideal candidate will possess strong analytical and communication skills, with a background in hospital billing and reimbursement processes. Join a team dedicated to enhancing the revenue cycle and ensuring compliance with healthcare regulations while maintaining strong relationships with third-party payers.

Qualifications

• 4+ years of experience in coding, billing, or denial management in a clinical setting.
• Strong understanding of federal and state healthcare regulations.

Responsibilities

• Review technical denial claims and submit appeals to optimize financial outcomes.
• Collaborate with revenue cycle departments to establish best practices.

Skills

Hospital billing knowledge

Reimbursement processes

Denial management

Analytical skills

Communication skills

Microsoft Office Suite proficiency

Education

High school diploma

Associate's degree in health or business-related fields

Job description

Enterprise Denial Analyst (Remote in Florida or Georgia) I Enterprise Denials I Day | Full-Time

Join to apply for the Enterprise Denial Analyst (Remote in Florida or Georgia) I Enterprise Denials I Day | Full-Time role at UF Health

Overview

The Enterprise Denial Analyst is responsible for reviewing technical denial claims, submitting reconsiderations or appeals. Reporting to the Enterprise Technical Denial Assistant Manager, this role aims to optimize the financial outcomes of the hospital-based revenue cycle by maintaining a low denial rate and high reimbursement rate at an enterprise level for UF Health. The analyst conducts root cause analysis of denied payments through research of patient stays and treatments, review of payer contracts, analysis of historical denials and their outcomes, and monitoring emerging trends in payer practices and requirements. They work to maintain strong third-party payer relationships, respond to inquiries, complaints, and other correspondence, and collaborate with the Enterprise Managed Care Department to escalate and resolve atypical denial issues. Knowledge of applicable state and federal laws related to contracts and the appeals process is essential.

The analyst is considered a technical denial expert, ensuring all denied claims are accurately managed from a billing perspective. They collaborate with revenue cycle departments across the enterprise to establish best practices that maximize reimbursement and minimize organizational write-offs.

Qualifications

Minimum Education and Experience Requirements

• High school diploma required; four (4) years of experience in coding, billing, insurance follow-up, collections, or denial management in a hospital/clinical setting.
• Preferred: Associate's degree or higher in health or business-related fields with at least 3 years of relevant experience.

Knowledge, Skills, Abilities

• Knowledge of hospital billing, reimbursement, denials, appeals, and third-party contracts.
• Understanding of federal and state healthcare regulations.
• Strong critical thinking, analytical, and research skills.
• Attention to detail, ability to work independently, and proficient organizational skills.
• Excellent communication and writing skills.
• Ability to prioritize, manage time effectively, and proficient in Microsoft Office Suite.
• Knowledge of HIPAA guidelines and the ability to interpret EOBs.
• High comfort level with computer systems and problem-solving skills.

Licensure/Certification/Registration: None required.

Motor Vehicle Operator Designation: Not applicable.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Information Technology
• Industries: Hospitals and Healthcare