Denial Recovery Analyst | Enterprise Denials - Durbin Park

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 quality standards, including managing an average of 60 accounts per day while maintaining 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, authorizations, and documentation requests.
• Initiate, track, and follow up on appeals to prevent timely filing denials and maximize reimbursement opportunities.
• Evaluate accounts and drive resolution using remittance advice, denial codes, payer portals, and payer communications.
• Identify payer-specific denial trends and escalate findings to leadership with actionable recommendations for root cause analysis.
• Collaborate with coding, billing, clinical, and revenue cycle teams to improve workflows and reduce future denials.
• Review payer policies, reimbursement guidelines, and communications to remain current on regulatory and industry changes.
• Proactively identify and resolve at-risk accounts receivable to minimize revenue loss and ensure compliance with contractual deadlines.
• Maintain detailed account documentation and ensure all actions are accurately recorded within designated systems.
• Support organizational revenue integrity initiatives through denial prevention, reimbursement optimization, and process improvement efforts.
• Serve as a subject matter resource for denial resolution, payer requirements, and reimbursement best practices.

Qualifications

• A high school diploma or GED is required.
• Minimum of four (4) years of experience in billing, insurance follow-up, collections, or denial management within a hospital or clinical setting.
• A preferred qualification is an associate’s degree or higher in a health or business-related field.
• Experience in coding, medical record review, auditing, or insurance-related functions is preferred.
• Experience supporting data governance and security policies is beneficial.
• Strong skills in report and dashboard development are advantageous.
• The ability to monitor BI tools and recommend process improvements is helpful.