Remote Denials & Appeals Specialist

Rhode Island Hospital; United States; Hybrid; USD 60,000 - 90,000; Full time

Job summary

Rhode Island Hospital is seeking a Denials Management Analyst to maximize reimbursement from contracted payers through detailed analysis of denials and efficient management of the appeal process. The role emphasizes data-driven tracking, root-cause analysis, and collaboration with hospital departments to ensure timely resolutions.

Responsibilities include reviewing denial reports, identifying trends, and supporting policy/compliance requirements while participating in continuous improvement

Qualifications

• Experience in denial management and third-party payer appeals processes.

Responsibilities

• Evaluates denied accounts for review and assigns to appropriate work queues.
• Identifies repetitive denial issues and recommends preventative solutions.
• Reviews denial database to categorize provider liable denials, root causes and resolutions.
• Tracks appeal status with organized records to meet timelines.
• Maintains relationships with hospital departments and referring physicians for information needed to overturn denials.
• Keeps current knowledge of state/federal regulations and payer policies to identify denial causes.

Skills

Denials management

Appeals process

Data analysis

Job description

Rhode Island Hospital is seeking a Denials Management Analyst to maximize reimbursement from contracted payers through detailed analysis of denials and efficient management of the appeal process. The role emphasizes data-driven tracking, root-cause analysis, and collaboration with hospital departments to ensure timely resolutions.

Responsibilities include reviewing denial reports, identifying trends, and supporting policy/compliance requirements while participating in continuous improvement