Denial Recovery Analyst | Enterprise Denials

Overview:

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: