The posting
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
Minimum 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.
