Denials Specialist TC
Core
Maximize reimbursement from contracted payers by analyzing, tracking, and resolving claim denials and appeals for a comprehensive academic health system.
Role type
Denials Management Specialist
Builds
Denial resolution workflows and payer appeal processes
Domain
Healthcare administration / Revenue Cycle Management
Required skills
Claims administration, Root cause analysis, Regulatory compliance (state/federal), Financial analysis, Report generation, Payer contract knowledge
Preferred skills
Process re-design, Strategic initiative execution
Technologies
LifeChart, Microsoft Teams, ICD-10, CPT-4, UB04, HCFA 1500
Responsibilities
Evaluate and assign denied accounts for resolution; Review denial databases to categorize provider liable denials and identify root causes; Execute the appeal process with third-party payers; Develop and maintain relationships with hospital departments and referring physician offices; Track appeal status and maintain organized records; Create ad hoc reports for departmental operations.
Seniority
Mid-level, independent contributor