Hospital Denials & Revenue Recovery Strategist

Quest Group Executive Search and Staffing Solutions; Redondo Beach (CA); On-site; USD 60,000 - 90,000; Full time

Job summary

Quest Group Executive Search and Staffing Solutions is partnering with a healthcare organization to recruit an experienced Hospital Revenue Recovery & Denials Specialist for our revenue cycle team. You will dig into complex denials, pursue recovery, and collaborate across Patient Financial Services, Coding, HIM, and Managed Care teams to enhance reimbursement performance.

The role requires a strong background in acute care hospital billing and denial management, with the analytical skills to

Qualifications

• 3+ years in hospital revenue cycle operations focusing on denial management, appeals, billing or AR.
• Experience in an acute care hospital or health system environment.

Responsibilities

• Investigate, analyze, and resolve denied, rejected, and underpaid hospital claims across Medicare, Medicaid, commercial, and managed care payers.
• Prepare, submit, and track appeals, reconsiderations, and payer escalations with deadlines.
• Review EOBs, ERAs, medical records, payer correspondence, and account documentation to determine denials' causes.
• Identify denial trends involving medical necessity, authorizations, eligibility, timely filing, coding, documentation, and reimbursement.
• Collaborate with Revenue Cycle teams to resolve issues and improve processes.
• Monitor denial trends, appeal outcomes, recovery dollars, and AR performance.
• Recommend process improvements to reduce preventable denials and improve clean claim rates.

Skills

Denial management

Hospital billing

Data analysis

Payer portals

Education

Associate degree in healthcare administration

Bachelor's degree in healthcare administration

Tools

Excel

Job description

Quest Group Executive Search and Staffing Solutions is partnering with a healthcare organization to recruit an experienced Hospital Revenue Recovery & Denials Specialist for our revenue cycle team. You will dig into complex denials, pursue recovery, and collaborate across Patient Financial Services, Coding, HIM, and Managed Care teams to enhance reimbursement performance.

The role requires a strong background in acute care hospital billing and denial management, with the analytical skills to