Denials Specialist

Westchester Medical Center•Valhalla, NY

About The Position

The Denials Specialist provides analysis and reporting for Denial Management functions at Westchester Medical Center Health Network. The role tracks and monitors denial write-offs to support net revenue recognition and recovery while maintaining the integrity of the denial process. Working under the direction of the Denial Manager, the specialist analyzes denial and underpayment reports, identifies root causes, and develops denial resolution strategies. The position also collaborates across Revenue Cycle teams and supports performance monitoring, operational improvement, and cash collection goals.

Requirements

Two to three years of experience in revenue cycle, denials management, or related patient financial services.
Demonstrated knowledge of healthcare management, collections management, Medicaid, and Medicare.
Experience establishing and managing claim denial activities, collection processes, and methodology.
Significant knowledge of healthcare payer reimbursement and proficiency with patient accounting systems.
Clear understanding of the impact Denials Management services have on Revenue Cycle operations and financial performance.
Knowledge of computer applications and equipment related to the work.
Strong organizational skills, including the ability to multitask, prioritize, and complete tasks and projects on time.
Demonstrated written and verbal communication skills.
Ability to relate cooperatively and constructively with coworkers, administration, clinic departments, providers, community agencies, referral sources, and other health team members.
Ability to work in a fast-paced environment and remain flexible under stressful situations.

Nice To Haves

Bachelor’s degree in business, finance, or healthcare administration preferred; equivalent work experience may substitute for the degree requirement.

Responsibilities

Coordinate data collection, analysis, appeals, write-offs, and reporting activities related to the denial process.
Communicate with clinical departments, on-site staff, and Patient Access and Mid-Cycle coordinators to reduce recurring denials and establish prevention measures.
Ensure Denial Management activities meet department requirements, maximize revenue collection, and achieve leading-practice performance levels.
Work with Revenue Integrity Leaders on charge-related denials.
Monitor denial write-offs to ensure staff use appropriate write-off codes.
Monitor denial vendor relationships for compliance and performance, and suggest modifications to Revenue Cycle leadership as needed.
Monitor contract compliance and escalate issues to Managed Care staff as needed.
Provide denial trends to the Billing Functional Leader to support operational improvement.
Work with Local System Coding leaders to determine appropriate changes for DRG-, CPT-, and ICD PX-related denials.
Maintain a flexible, customer-service-oriented approach with internal and external constituents, emphasizing service satisfaction and quality.
Analyze denial and underpayment reports under the direction of the Denial Manager, provide feedback on root causes, and formulate resolution strategies.
Work with the Follow-up Manager to establish and monitor accounts receivable management and cash collection goals and targets.
Create a department dashboard.
Ensure key performance metrics are met daily, weekly, and monthly under the direction of the Denial Manager.
Use automated systems effectively to perform work assignments.
Perform related duties as assigned.