Hospital Revenue Cycle: Denials & Appeals Specialist

The Staff Pad; Ohio; Presencial; USD 55.000 - 75.000; Jornada completa

Descripción de la vacante

The Staff Pad partners with a reputed healthcare organization in Hamilton, TX and we are seeking a detail-oriented Claims Denials & Appeals Specialist to support revenue cycle operations.

This full-time role focuses on resolving claim denials, managing appeals, identifying reimbursement discrepancies, and helping improve claims processes to support timely and accurate payments. The position requires 1+ year of hospital revenue cycle experience, with 2+ years preferred.

Formación

• High school diploma or equivalent required.
• Associate degree or coursework in healthcare administration, business, medical billing or related field preferred.
• 1+ year of hospital revenue cycle experience involving denials, appeals, or insurance follow-up required.
• 2+ years of relevant experience preferred.
• Knowledge of hospital billing, payer requirements, EOBs, remittance advice, claim adjustment codes, and appeals processes.
• Relevant revenue cycle or billing certification preferred.

Responsabilidades

• Review, resolve, and track assigned claim denials and appeals.
• Identify recurring denial trends and support prevention efforts.
• Review payment discrepancies against payer contracts and reimbursement guidelines.
• Follow up on underpayments and pursue appropriate reimbursement recovery.
• Communicate unresolved payment issues and trends to leadership.
• Maintain accurate work queues, documentation, and reports to support reimbursement, timely filing, and departmental improvement.
• Manage assigned inpatient, outpatient, ED, surgery, swing bed, rural health clinic, and professional claims across commercial and government payers.
• Coordinate with clinical and administrative teams to support timely claim resolution and reimbursement.
• Manage assigned payer and service responsibilities, including non-traditional Medicare appeals, clinical appeals, payment variances, and discharged-not-final-billed (DNFB) follow-up.

Conocimientos

Analytical skills

Organizational skills

Documentation skills

Communication skills

Attention to detail

Educación

High school diploma

Associate degree or coursework in healthcare administration, business, medical billing

Herramientas

Excel

EHR systems

Clearinghouse queues

Payer portals

Descripción del empleo

The Staff Pad partners with a reputed healthcare organization in Hamilton, TX and we are seeking a detail-oriented Claims Denials & Appeals Specialist to support revenue cycle operations.

This full-time role focuses on resolving claim denials, managing appeals, identifying reimbursement discrepancies, and helping improve claims processes to support timely and accurate payments. The position requires 1+ year of hospital revenue cycle experience, with 2+ years preferred.