Enterprise Denial Analyst | Enterprise Denials | Day | Full-Time

7 days ago

Gainesville, United States UF Health Full time

OverviewThe Enterprise Denial Analyst is responsible for reviewing technical denial claims and submitting reconsiderations or appeals. Reporting to the Enterprise Technical Denial Assistant Manager, this role supports the optimization of financial outcomes for UF Health's hospital-based revenue cycle by maintaining a low denial rate and achieving a high reimbursement rate across the enterprise.The Enterprise Denial Analyst conducts root cause analyses of denied payments through comprehensive methods, including but not limited to: Researching patient stays and treatments Reviewing payer contracts Analyzing historical denials, appeals, and their outcomes Identifying and monitoring emerging trends in payer practices and requirements This position also maintains third-party payer relationships, responding to inquiries, complaints, and other correspondence in a professional and timely manner.In collaboration with the Enterprise Technical Denial Assistant Manager and Enterprise Senior Denial Manager, the analyst works closely with the Enterprise Managed Care Department to escalate and resolve atypical denial issues. The role requires a strong understanding of state and federal laws related to contracts and the appeals process.As a technical denial expert, the Enterprise Denial Analyst ensures that all denied claims are accurately addressed from both a technical and billing perspective. This role collaborates with departments across the revenue cycle enterprise to develop and implement best practice solutions that maximize reimbursement and minimize organizational write-offs.QualificationsMinimum Education and Experience RequirementsEducation & Experience Required: High school diploma or equivalent. Four (4) years of experience in coding or billing, insurance follow-up, collections, or denial management in a hospital or clinical setting. Preferred: Associate's degree or higher in a health or business-related field. Three (3) years of experience in coding or billing, insurance follow-up, collections, or denial management in a hospital or clinical setting. Knowledge, Skills, and Abilities Demonstrated knowledge of: Hospital billing and reimbursement Denials and appeals Third-party contracts Federal and state regulations governing the healthcare industry Excellent critical thinking and analytical skills Strong attention to detail with the ability to complete work accurately and independently Effective organizational skills Excellent written and verbal communication skills Ability to prioritize and manage time effectively Proficiency in Microsoft Office products (Outlook, Word, Excel) Knowledge of HIPAA guidelines Ability to read and interpret Explanations of Benefits (EOBs) Strong research and problem-solving abilities High level of comfort using computer systems Motor Vehicle Operator DesignationEmployees in this position will not operate vehicles for an assigned business purpose.Licensure/Certification/Registration None required

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