Denials Recovery Specialist I

NY United Health Services•Binghamton, NY

About The Position

The Denials Recovery Specialist I works in Denials Recovery within UHS Revenue Cycle Operations. The role resolves denied insurance claims, manages accounts receivable, and prepares reconsiderations and appeals for payor review to support timely reimbursement, revenue integrity, and patient access. The specialist reviews accounts, identifies claim issues, follows established guidelines, and works with the revenue cycle team. The position contributes to revenue integrity by resolving denied claims and exercising judgment within established guidelines to determine follow-up, escalation, and appeal actions. It also analyzes claim outcomes for trends related to payor behavior, system issues, and user errors, and shares insights with leadership to support process improvement and denial prevention. The specialist performs work in compliance with HIPAA regulations, payor policies, organizational standards, and security procedures. The role also supports onboarding and peer training, completes required training and competency validations, and carries out other responsibilities as needed by the department and organization.

Requirements

High school diploma or equivalent.
At least 1 year of direct experience performing the exact or very similar duties required by the job within the same role or function.
Up to 1 year of healthcare experience working in the healthcare industry in any job function.

Nice To Haves

Bachelor’s degree.

Responsibilities

Resolve denied insurance claims by reviewing accounts, identifying issues, and securing appropriate payment outcomes.
Manage assigned work queues to ensure timely and accurate resolution of denied and aging accounts receivable.
Prepare and submit formal reconsiderations and appeals to payors to support claim reprocessing and payment.
Draft clear, accurate appeal letters and supporting documentation aligned with payor requirements.
Perform denied-claims and accounts-receivable cleanup activities to support revenue cycle performance.
Adjust denials accurately in accordance with guidelines and goals.
Determine appropriate follow-up, escalation, and appeal actions within established guidelines.
Analyze claim outcomes to identify trends related to payor behavior, system issues, and user errors, and share insights with leadership.
Comply with HIPAA regulations, payor policies, organizational standards, and security procedures; protect sensitive data and report potential security incidents or risks.
Complete required training, education, and competency validations within established timelines, and maintain relevant revenue cycle and denial-management knowledge.
Support onboarding and peer training activities.
Demonstrate UHS Values of Compassion, Trust, Respect, Teamwork, and Innovation and perform additional responsibilities as needed.