Work remotely while using your denial management expertise to make a direct impact on healthcare operations. 💻 Work Style: Remote 📍 Location Requirement: Must reside in Florida or Georgia 🕒 FTE: Full-Time (1.0 FTE) Responsible for reviewing technical denial claims, submitting reconsiderations or appeals. Responsible to optimize the financial outcomes of revenue cycle through maintaining a low denial rate and high reimbursement rate at an enterprise level for UF Health.
Initiates a root cause analysis of denied payment through comprehensive means including but not limited to: research of patient stays and treatment, review of payer contracts, analysis of historical denials, appeals and their outcomes, emerging trends in payer practices and requirements. Works to maintain third-party payer relationships, including responding to inquiries, complaints and other correspondence. Working in conjunction with the Enterprise Technical Denial Assistance Manager and Enterprise Sr Denial Manager, maintains a strong working relationship with the Enterprise ManagedCare Department to escalate and resolve atypical denial issues.
Knowledgeable of state/federal laws that relate to contracts and to the appeals process. Considered a technical denial expert in denial management and ensures all denied claims are accurately worked from a technical/ billing perspective. Working in collaboration with the different revenue cycle departments through the enterprise to establish best practice solutions to maximize reimbursement and minimize organizational write-offs Responsibilities Key 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. Qualifications
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.