Pharmacy Denial Specialist, System Infusion Pharmacy HUB, FT, 8a-4:30p

Baptist Health South Florida; Florida; Vor Ort; USD 65.000 - 90.000; Vollzeit

Benefits dieser Stelle

Career growth

Health resources

Tuition reimbursement

Wellness program

Zusammenfassung

Baptist Health South Florida is seeking an experienced Denials Management Specialist to identify and streamline the denials process, improving recovery efforts and productivity. You will review medical record documentation for overturning medication-related denials from insurers and act as a resource for Denials Management across departments.

You will maintain a comprehensive file of denials and communicate findings to teammates and management, collaborating with a multidisciplinary team to

Qualifikationen

• Experience in denial management and cash collections in a hospital setting.
• Review medical record documentation for denial overturns.
• Maintain files to communicate issues to teammates and management.
• Collaborate with multidisciplinary team to improve denial processes.

Aufgaben

• Identify and streamline denials process to improve recovery.
• Review medical record documentation for denial overturns.
• Maintain denial issue files for team communication.
• Work with multidisciplinary team to enhance denial management and appeals process.
• Increase cash collections for the department.

Kenntnisse

Analytical thinking

Critical thinking

Detail oriented

Problem solving

Interpersonal skills

Time management

Teamwork

Independent work

Ausbildung

Associates degree

Tools

Soarian

JDA

Workstation Lists

Microsoft Excel

Jobbeschreibung

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors.

What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients' shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact - because when it comes to caring for people, we're all in.

At Baptist Health, we're committed to supporting our employees at every stage of their journey, both personally and professionally. Our approach is rooted in a "grow our own" philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including:

• Career growth and development opportunities, with clear pathways and ongoing support
• Comprehensive health and wellness resources that go beyond traditional benefits
• A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
• Tuition reimbursement to support continued learning and advancement
• And so much more

Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day.

Description

Identify and streamline the denials process in an effort to improve and optimize the recovery efforts and maximize productivity. Assist with the review of medical record documentation for the overturning of medication-related denials generated by insurance companies. Serves as a resource for Denials Management and other departments within BHSF to proactively avoid unnecessary appeals. Responsible for maintaining a file containing all pertinent information on denials and issues in order to communicate all issues to teammates and management. Work closely with a multidisciplinary team to evaluate and improve the denial management, documentation and appeals process. Engages in activities that produce an increase in cash collections for the department.

Qualifications:

Identify and streamline the denials process in an effort to improve and optimize the recovery efforts and maximize productivity. Assist with the review of medical record documentation for the overturning of medication-related denials generated by insurance companies. Serves as a resource for Denials Management and other departments within BHSF to proactively avoid unnecessary appeals. Responsible for maintaining a file containing all pertinent information on denials and issues in order to communicate all issues to teammates and management. Work closely with a multidisciplinary team to evaluate and improve the denial management, documentation and appeals process. Engages in activities that produce an increase in cash collections for the department.

Minimum Required Experience: 5 Years

Degrees:

• Associates.

Additional Qualifications:

• Prior experience in pharmacy, corporate operational setting or hospital business office preferred.
• RPT, CPhT, PTCB certification recommended.
• Experience using Soarian, JDA, Workstation Lists and Microsoft Excel.
• Wide range knowledge manipulating and compiling information using multiple systems.
• Analytical, critical thinking, detail oriented, problem solving, and interpersonal skills required.
• Ability to manage multiple tasks and have excellent organization skills while working under pressure in order to meet stringent deadlines.
• Initiative, attention to detail, follow-through skills and ability to work independently and within a team based department.
• Excellent time-management skills.
• Interpersonal skills, professional conduct and communication skills to effectively gather information, ask questions and discuss problems with internal personnel.

Minimum Required Experience: 5 Years