Revenue Cycle Denials Specialist — Appeals & Remediation

AdventHealth; Florida; Presencial; USD 57.192.000 - 106.202.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Paid time off

403-B retirement plan

Parental leave

Career development

Well-being resources

Mental health resources

Pet benefits

Descripción de la vacante

AdventHealth in Florida is seeking a denials management specialist to review and appeal denials across service lines. You will research account histories, payer interactions, and documents to determine optimal appeal strategies and ensure timely corrections.

The role requires strong knowledge of revenue cycle processes, CPT/HCPCS/ICD codes, and experience with Epic EHR. A proactive, detail-oriented worker will thrive in this team-oriented environment.

Formación

• Understanding of revenue cycle processes including charge capture and billing regulations.
• Knowledge of CPT, HCPCS, ICD codes, UB-04 Revenue Codes, and modifiers.
• Ability to navigate the electronic medical record and correlate services to charges.
• Strong critical thinking and problem-solving skills with ability to multi-task and reprioritize in a fast-paced environment.
• Self-starter with ability to work independently with limited day-to-day oversight.
• Strong written communication and grammatical skills.
• Technical proficiency within Patient Accounting systems and applicable vendor technologies for account research.
• Proficiency in Microsoft Suite applications, specifically Excel, Word, and Outlook.
• Ability to navigate payer websites and portals for research purposes.
• Proficiency with Epic EHR system (Preferred).
• Comfort with interpreting payer contractual language (Preferred).
• Experience with medical billing and remittance forms including 835 and 837 files, UB-04 and CMS-1500 forms (Preferred).

Responsabilidades

• Reviews and appeals denials across all service lines system-wide.
• Researches account histories, patient encounters, payer portals, and payment records to determine appropriate appeal strategies.
• Evaluates denial types including charge audit, charge capture, authorization, timely filing, and payer policy denials.
• Recommends charge corrections and prepares accounts for rebilling as appropriate.
• Collaborates with pre-access, patient financial services, revenue integrity, utilization management, and clinical departments to gather supporting documentation.
• Provides reports, education, and training on denial trends and recommended remediation strategies.
• Educates stakeholders on proper documentation, payer processes, and policies with a denial prevention focus.
• Drafts and submits written and verbal appeals using clear, concise terminology.
• Researches root causes, collects supporting documentation, and adjusts accounts based on internal and external findings.
• Utilizes multiple IT systems to compile comprehensive clinical and financial information for appeals.
• Escalates identified claim issues and trends to appropriate leadership or payer contacts.
• Performs other duties as assigned

Conocimientos

Revenue cycle

CPT/HCPCS/ICD codes

EMR navigation

Multi-tasking

Independent work

Written communication

Excel

Payer portals

Epic EHR

Contract language

Educación

High School diploma

Bachelor's degree

Herramientas

Epic EHR

Microsoft Excel

Payer portals

Descripción del empleo

AdventHealth in Florida is seeking a denials management specialist to review and appeal denials across service lines. You will research account histories, payer interactions, and documents to determine optimal appeal strategies and ensure timely corrections.

The role requires strong knowledge of revenue cycle processes, CPT/HCPCS/ICD codes, and experience with Epic EHR. A proactive, detail-oriented worker will thrive in this team-oriented environment.