Senior Denials & Appeals Analyst – Remote

Advocate Health; United States; Remote; USD 37,000 - 55,000; Full time

Benefits offered by this job

Health benefits

Paid time off

Educational assistance

Employer 401(k) match

Job summary

Advocate Health is seeking a Remote Denials Specialist to support the Revenue Recovery Appeals team. This is a fully remote, full-time role requiring 40 hours per week and compensation within the stated pay range.

The position involves researching denied claims, gathering medical documentation, writing appeal letters, and coordinating with payors to maximize eligible reimbursements. The ideal candidate has a Bachelor’s degree in Finance or related field, 3 years of hospital billing or denials

Qualifications

• Bachelor’s Degree in Finance, or related field, or equivalent knowledge.
• Typically requires 3 years of experience in hospital billing, finance, medical necessity denials management, coding or related field.
• Experience with CPT/HCPCS coding nomenclature, ICD-9/ICD10 coding conventions, and medical terminology.
• Knowledge of appeals criteria and federal, state and local regulations.
• Excellent writing and analytical skills with attention to detail.

Responsibilities

• Researches and analyzes denied claims to ensure compliance with payor and government rules and determines appeal appropriateness.
• Secures needed medical documentation to support the appeal process.
• Reviews accounts and writes appeal letters for technical denials based on medical necessity.
• Collaborates with staff on denial-related issues.
• Prepares claims for clinical appeal processing in case of authorization and medical necessity denials.
• Utilizes provider billing manuals to meet billing guidelines and shares information as needed.
• Prioritizes appeals according to payor contracts and documents denial status in denial software.
• Identifies payor trends and communicates findings to leadership.
• Meets monthly with Denial Prevention Advisor to discuss trends and revenue opportunities.
• Maintains caseload and monitors daily appeal decision timelines.

Skills

Analytical thinking

Strong writing skills

Microsoft Office proficiency

Deadline oriented

Team collaboration

Education

Bachelor’s Degree in Finance or related field

Tools

Denial software

Job description

Advocate Health is seeking a Remote Denials Specialist to support the Revenue Recovery Appeals team. This is a fully remote, full-time role requiring 40 hours per week and compensation within the stated pay range.

The position involves researching denied claims, gathering medical documentation, writing appeal letters, and coordinating with payors to maximize eligible reimbursements. The ideal candidate has a Bachelor’s degree in Finance or related field, 3 years of hospital billing or denials