Denial Analyst Jobs

About The Position

Requirements

• High School Diploma or GED required; Associate's degree or higher in a health or business-related field preferred.
• Four (4) years of experience in medical coding, billing, insurance follow-up, collections, or denial management in a hospital or clinical setting.
• Experience with medical coding, medical record review, auditing, or insurance processes preferred.
• Experience supporting data governance, data quality, and security policies.
• Strong skills in report and dashboard development.
• Ability to monitor business intelligence tools, analyze performance, and recommend process improvements.

Responsibilities

• Identifies, prioritizes, and resolves denied claims or initiates appeals to maximize reimbursement.
• Interprets and applies payer contract terms, billing policies, and reimbursement guidelines.
• Reviews and responds to EOBs, denial letters, appeal determinations, and documentation requests in a timely and professional manner.
• Meets established productivity and quality standards while managing assigned denial workqueues.
• Manages multiple payer workqueues, including Medicare, Medicaid, government, commercial, and Medicare Advantage plans.
• Researches and resolves denials related to eligibility, registration, billing, documentation, and insurance follow-up, initiating timely appeals to prevent filing deadlines.
• Evaluates accounts using remittances, denial reason codes, remark codes, and payer communications to drive claim resolution.
• Prepares, submits, and follows up on appeals and reconsiderations to optimize reimbursement and protect organizational revenue.
• Identifies payer-specific denial trends, escalates root causes, and recommends process improvements to reduce future denials.
• Collaborates with revenue cycle teams to improve registration, charge capture, billing edits, and other upstream processes that prevent denials.
• Monitors payer policy changes, identifies reimbursement risks, and ensures compliance with billing regulations and best practices.
• Identifies and resolves at-risk accounts receivable to minimize revenue loss and meet contractual filing deadlines.