Remote Denial Recovery Analyst, Enterprise Claims

UF Health; Gainesville (FL); A distancia; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

UF Health in Florida seeks a remote Denial Management Specialist to review denied claims, submit reconsiderations or appeals, and optimize enterprise revenue by lowering denial rates and increasing reimbursement. This role supports multiple payer plans within a healthcare revenue cycle framework.

The position requires four years of medical coding/billing or denial management experience, strong BI/dashboard skills, and knowledge of payer contract terms. Florida or Georgia residency is needed.

Formación

• Four (4) years of experience in medical coding, billing, insurance follow‑up, collections, or denial management in a hospital or clinical setting.
• Experience with medical coding, medical record review, auditing, or insurance processes preferred.
• Experience supporting data governance, data quality, and security policies.
• Strong skills in report and dashboard development.
• Ability to monitor business intelligence tools, analyze performance, and recommend process improvements.

Responsabilidades

• Identifies, prioritizes, and resolves denied claims or initiates appeals to maximize reimbursement.
• Interprets and applies payer contract terms, billing policies, and reimbursement guidelines.
• Reviews and responds to EOBs, denial letters, appeal determinations, and documentation requests in a timely and professional manner.
• Meets established productivity and quality standards while managing assigned denial workqueues.
• Manages multiple payer workqueues, including Medicare, Medicaid, government, commercial, and Medicare Advantage plans.
• Researches and resolves denials related to eligibility, registration, billing, documentation, and insurance follow‑up, initiating timely appeals to prevent filing deadlines.
• Evaluates accounts using remittances, denial reason codes, remark codes, and payer communications to drive claim resolution.
• Prepares, submits, and follows up on appeals and reconsiderations to optimize reimbursement and protect organizational revenue.
• Identifies payer‑specific denial trends, escalates root causes, and recommends process improvements to reduce future denials.
• Collaborates with revenue cycle teams to improve registration, charge capture, billing edits, and other upstream processes that prevent denials.
• Monitors payer policy changes, identifies reimbursement risks, and ensures compliance with billing regulations and best practices.
• Identifies and resolves at‑risk accounts receivable to minimize revenue loss and meet contractual filing deadlines.

Conocimientos

Reporting & dashboards

BI monitoring

Process improvements

Educación

High School Diploma or GED

Associate's degree or higher in health or business

Descripción del empleo

UF Health in Florida seeks a remote Denial Management Specialist to review denied claims, submit reconsiderations or appeals, and optimize enterprise revenue by lowering denial rates and increasing reimbursement. This role supports multiple payer plans within a healthcare revenue cycle framework.

The position requires four years of medical coding/billing or denial management experience, strong BI/dashboard skills, and knowledge of payer contract terms. Florida or Georgia residency is needed.