Hospital Revenue Recovery & Denials Specialist

Quest Group Executive Search and Staffing Solutions; Redondo Beach (CA); Presencial; USD 60.000 - 90.000; Jornada completa

Descripción de la vacante

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

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

Denial management

Hospital billing

Data analysis

Payer portals

Educación

Associate degree in healthcare administration

Bachelor's degree in healthcare administration

Herramientas

Excel

Descripción del empleo

We are partnering with an established healthcare organization seeking an experienced Hospital Revenue Recovery & Denials Specialist to join its revenue cycle team.

This individual will play an important role in identifying and resolving complex insurance denials, recovering underpayments, and improving overall reimbursement performance. The ideal candidate will bring a strong background in acute care hospital billing, denial management, and payer reimbursement, along with the analytical skills to identify trends and help prevent recurring revenue loss.

This is an excellent opportunity for someone who enjoys digging into complex reimbursement issues, working across departments, and making a measurable impact on financial performance.

Key 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 while ensuring compliance with filing deadlines.


• Review EOBs, ERAs, medical records, payer correspondence, and account documentation to determine the underlying causes of denials.


• Identify denial trends involving medical necessity, authorizations, eligibility, timely filing, coding, documentation, and contractual reimbursement.


• Research complex and high dollar accounts to identify opportunities for additional reimbursement.


• Collaborate with Patient Financial Services, Patient Access, Case Management, Coding, HIM, Revenue Integrity, and Managed Care teams to resolve issues and improve processes.


• Analyze reimbursement discrepancies and pursue recovery through appeals, corrected claims, rebilling, and payer follow up.


• Monitor denial trends, appeal outcomes, recovery dollars, and accounts receivable performance.


• Recommend process improvements designed to reduce preventable denials and improve clean claim rates.


• Maintain accurate account documentation and ensure compliance with applicable payer and regulatory requirements.

Qualifications

• Minimum of 3 years of experience in hospital revenue cycle operations, with an emphasis on denial management, appeals, billing, or accounts receivable.


• Experience working within an acute care hospital or health system environment.


• Strong understanding of Medicare, Medicaid, commercial insurance, and managed care reimbursement.


• Demonstrated ability to investigate complex claim denials and pursue reimbursement recovery.


• Familiarity with hospital billing systems, electronic health records, and payer portals.


• Working knowledge of UB04 claims, ICD10, CPT, HCPCS, and general hospital reimbursement methodologies.


• Strong analytical, organizational, and problem solving skills.


• Proficiency in Microsoft Excel and experience working with denial reports and reimbursement data.


• Ability to work independently while collaborating with clinical, financial, and operational teams.

Preferred Experience

• Experience analyzing payer contracts and identifying reimbursement variances.


• Background handling complex inpatient and outpatient hospital denials.


• Experience developing denial prevention strategies and identifying root causes.


• Associate or bachelor's degree in healthcare administration, business, finance, or a related field. Relevant experience will also be considered.

What We're Looking For

We are particularly interested in candidates who understand the full hospital revenue cycle and can go beyond simply working a denial queue. The right individual will be comfortable investigating complicated reimbursement issues, recognizing patterns, communicating with payers, and identifying opportunities to prevent future denials.

Strong hospital experience, attention to detail, and the ability to work through complex accounts are essential.