Denials Management Specialist

Our Promise To You Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability InsurancePaid Time Off from Day One403-B Retirement Plan4 Weeks 100% Paid Parental LeaveCareer DevelopmentWhole Person Well-being ResourcesMental Health Resources and SupportPet Benefits Schedule Full time Shift Day (United States of America) Address 900 HOPE WAY City ALTAMONTE SPRINGS State Florida Postal Code 32714 Job Description Reviews and appeals denials across all service lines system-wideResearches account histories, patient encounters, payer portals, and payment records to determine appropriate appeal strategiesEvaluates denial types including charge audit, charge capture, authorization, timely filing, and payer policy denialsRecommends charge corrections and prepares accounts for rebilling as appropriateCollaborates with pre-access, patient financial services, revenue integrity, utilization management, and clinical departments to gather supporting documentationProvides reports, education, and training on denial trends and recommended remediation strategiesEducates stakeholders on proper documentation, payer processes, and policies with a denial prevention focusDrafts and submits written and verbal appeals using clear, concise terminologyResearches root causes, collects supporting documentation, and adjusts accounts based on internal and external findingsUtilizes multiple IT systems to compile comprehensive clinical and financial information for appealsEscalates identified claim issues and trends to appropriate leadership or payer contactsPerforms other duties as assigned Knowledge, Skills, And Abilities Understanding of revenue cycle processes including charge capture and billing regulations [Required]Knowledge of CPT, HCPCS, ICD codes, UB-04 Revenue Codes, and modifiers [Required]Ability to navigate the electronic medical record and correlate services to charges [Required]Strong critical thinking and problem-solving skills with ability to multi-task and reprioritize in a fast-paced environment [Required]Self-starter with ability to work independently with limited day-to-day oversight [Required]Strong written communication and grammatical skills [Required]Technical proficiency within Patient Accounting systems and applicable vendor technologies for account research [Required]Proficiency in Microsoft Suite applications, specifically Excel, Word, and Outlook [Required]Ability to navigate payer websites and portals for research purposes [Required]Proficiency with Epic EHR system [Preferred]Comfort with interpreting payer contractual language [Preferred]Experience with medical billing and remittance forms including 835 and 837 files, UB-04 and CMS-1500 forms [Preferred] Education High School Grad or Equiv [Required]Bachelors [Preferred] Work Experience 3+ years of denials management or revenue cycle experience [Required]5+ years of denials management or revenue cycle experience [Preferred] Licenses And Certifications Certified Revenue Cycle Rep (CRCR) [Preferred] Physical Requirements: (Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/23km2677 Pay Range $19.96 - $37.11 Background Screening Requirement (Florida Law) Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law. Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/ This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.