The Technical Denials Specialist plays a critical role in the health systems revenue cycle operations by managing and appealing payer denials with a strong focus on medical necessity authorization and eligibility issues. This position is responsible for identifying root causes preparing and submitting appeals and providing actionable feedback to key departments such as Patient Access and Registration. Through data analysis reporting and cross-functional collaboration this role helps drive improvements that reduce denials and ensure optimal reimbursement.MISSION VALUES and SERVICE GOALSMISSIONWe deliver outstanding care inspire health and connect with heart.VALUESTrust. Respect. Integrity. Compassion.SERVICE GOALSPersonally connect. Keep everyone informed. Be on their team.Principal Duties and ResponsibilitiesManages the end-to-end process for claim denials and appeals including receipt analysis documentation submission and resolution with third-party payers.Handles denials related to eligibility medical necessity prior authorization non-coverage and coding errors.Performs root cause analysis to identify trends in denials and collaborates with internal stakeholders particularly Patient Access and Registration to provide feedback and recommend process improvements.Submits timely and accurate appeals with appropriate supporting documentation and in accordance with payer guidelines and timelines.Prepares and distributes monthly denial trend reports and dashboards to Revenue Cycle leadership highlighting key findings financial impacts and suggested corrective actions.Works closely with Revenue Cycle leadership to develop and implement preventative strategies aimed at reducing eligibility and authorization-related denials.Recommends enhancements to claim edits workflows or registration practices to reduce recurring denial types.Reviews payer correspondence and authorization requirements to assess financial risk and initiate retro-authorization requests when appropriate.Maintains accurate records of all appeals activity and correspondence ensuring compliance with internal policies and external regulations.Ensures adherence to HIPAA fraud and abuse laws and organizational policies related to data security and confidentiality.Maintains effective communication with payers and internal stakeholders demonstrating professionalism urgency and accountability.Engages in continuous learning to stay updated on payer requirements industry changes and revenue cycle best practices.ORGANIZATIONAL RESPONSIBILITIESAssociate complies with the following organizational requirementsAttends and participates in department meetings and is accountable for all information shared.Completes mandatory education annual competencies and department specific education within established timeframes.Completes annual employee health requirements within established timeframes.Maintains licensecertification registration in good standing throughout fiscal year.Direct patient care providers are required to maintain current BCLS CPR and other certifications as required by positiondepartment.Consistently utilizes appropriate universal precautions protective equipment and ergonomic techniques to protect patient and self.Adheres to regulatory agency requirements survey process and compliance.Complies with established organization and department policies.Available to work overtime in addition to working additional or other shifts and schedules when required.Commitment to Beacons six-point Operating System referred to as The Beacon WayLeverage innovation everywhere.Cultivate human talent.Embrace performance improvement.Build greatness through accountability.Use information to improve and advance.Communicate clearly and continuously.Education and ExperienceThe knowledge skills and abilities as indicated below are normally acquired through the successful completionof aBachelors degree requiredpreferably in Health Administration Business Public Health or a related field.Minimum of 3 years of experience in hospital revenue cycle operations with emphasis on denial management and appeals.Knowledge & SkillsStrong understanding of hospital registration eligibility verification and payer authorization processes.Experience analyzing denial trends and providing actionable insights to cross-functional teams.Proficient in Microsoft Office hospital billing systems and electronic health records EHR.Exceptional analytical organizational and written communication skills.Ability to work independently manage competing priorities and collaborate effectively with clinical and non-clinical departments.Working ConditionsWorks in an office environment.Physical DemandsRequires the physical ability and stamina to perform the essential functions of the position.