Denial Recovery Analyst | Enterprise Denials | Remote (must reside in FL, GA, PA, NC, SC, TN or TX)

UF Health•Gainesville, FL

19h•Remote

About The Position

Responsible for reviewing technical denial claims and submitting reconsiderations or appeals. Optimizes financial outcomes within the revenue cycle by maintaining low denial rates and maximizing reimbursement across the enterprise. Conducts root cause analysis of denied payments through comprehensive review of patient encounters, payer contracts, historical denial trends, and appeal outcomes. Mains strong relationships with third-party payers, responding to inquiries, complaints, and correspondence. Collaborates with Enterprise Technical Denial Assistance leadership and Managed Care to escalate and resolve complex denial issues. Ensures compliance with state and federal regulations related to contracts and appeals. Serves as a subject matter expert in denial management, ensuring accurate resolution of denied claims from a technical and billing perspective. Partners with revenue cycle departments across the enterprise to implement best practices that improve reimbursement and reduce organizational write-offs.

Requirements

High School Diploma or GED required
Minimum of four (4) years of experience in coding, billing, insurance follow-up, collections, or denial management within a hospital or clinical setting

Nice To Haves

Associate’s degree or higher in a health or business-related field
Experience in coding, medical record review, auditing, or insurance-related functions
Experience supporting data governance and security policies
Strong skills in report and dashboard development
Ability to monitor BI tools and recommend process improvements

Responsibilities

Identify, prioritize, and resolve denied claims, including initiating timely appeals and reconsiderations
Interpret and apply payer contract terms to ensure accurate claim resolution and reimbursement
Conduct internal and external correspondence clearly, professionally, and in compliance with organizational standards
Review and take appropriate action on EOBs, denial letters, appeal determinations, and documentation requests in a timely manner
Meet productivity and accuracy standards, including working an average of 60 accounts per day with a 98% accuracy rate
Manage and work multiple payer workqueues, including Medicare, Medicaid, government, commercial, and Medicare Advantage plans
Research and resolve denials related to eligibility, registration, billing errors, missing information, and documentation requests
Initiate and follow up on appeals to prevent timely filing denials and ensure optimal reimbursement outcomes
Evaluate accounts and drive resolution using tools such as remittance advice, denial codes, and payer communications
Identify payer-specific denial trends and escalate findings to leadership with actionable insights for root cause analysis
Collaborate with revenue cycle teams across the enterprise to recommend process improvements and prevent future denials
Review payer policies and communications to identify risks to reimbursement and stay current on regulatory and industry best practices
Proactively identify and resolve at-risk A/R to minimize revenue loss and ensure compliance with contractual deadlines