Denial Recovery Analyst | Enterprise Denials

Responsibilities

• Identify, prioritize, and resolve denied claims, including initiating timely appeals and reconsiderations
• Interpret and apply payer contract terms to ensure accurate claim resolution and reimbursement
• Conduct internal and external correspondence clearly, professionally, and in compliance with organizational standards
• Review and take appropriate action on EOBs, denial letters, appeal determinations, and documentation requests in a timely manner
• Meet productivity and accuracy standards, including working an average of 60 accounts per day with a 98% accuracy rate
• Manage and work multiple payer workqueues, including Medicare, Medicaid, government, commercial, and Medicare Advantage plans
• Research and resolve denials related to eligibility, registration, billing errors, missing information, and documentation requests
• Initiate and follow up on appeals to prevent timely filing denials and ensure optimal reimbursement outcomes
• Evaluate accounts and drive resolution using tools such as remittance advice, denial codes, and payer communications
• Identify payer-specific denial trends and escalate findings to leadership with actionable insights for root cause analysis
• Collaborate with revenue cycle teams across the enterprise to recommend process improvements and prevent future denials
• Proactively identify and resolve at-risk A/R to minimize revenue loss and ensure compliance with contractual deadlines

Qualifications

• High School Diploma or GED required
• Minimum of four (4) years of experience in billing, insurance follow-up, collections, or denial management within a hospital or clinical setting
• Associate’s degree or higher in a health or business-related field preferred
• Experience in coding, medical record review, auditing, or insurance-related functions preferred
• Strong skills in report and dashboard development
• Ability to monitor BI tools and recommend process improvements