Enterprise Denial Analyst (Remote Florida or Georgia)

This position is posted by Jobgether on behalf of a partner company. We are currently looking for an Enterprise Denial Analyst in Florida (USA) or Georgia (USA).

In this role, you will be responsible for reviewing and managing technical denial claims, submitting reconsiderations or appeals, and helping optimize the financial outcomes of hospital-based revenue cycles. You will perform root cause analyses of denied payments, identify trends in payer practices, and collaborate with cross-functional teams to ensure timely resolution and process improvement. The role requires strong analytical and communication skills, a deep understanding of healthcare billing and reimbursement processes, and a focus on maintaining positive relationships with third-party payers. This position offers the opportunity to directly impact organizational financial integrity and contribute to continuous improvement initiatives in a remote work environment authorized in FL and GA.

Accountabilities:

• Review, analyze, and process technical denial claims, submitting appeals or reconsiderations as necessary.
• Conduct root cause analyses of denied payments by reviewing patient stays, treatment records, payer contracts, and historical denials.
• Identify trends in payer requirements and emerging issues to proactively improve processes.
• Maintain positive relationships with third-party payers, addressing inquiries, complaints, and correspondence.
• Escalate atypical denial issues in collaboration with management and the managed care department to ensure resolution.
• Support continuous improvement initiatives and help streamline denial management workflows.

• High school diploma or equivalent required; Associate’s degree or higher in healthcare or business-related field preferred.
• Minimum of 4 years of experience in coding, billing, insurance follow-up, collections, or denial management within a hospital or clinical setting.
• Knowledge of hospital billing and reimbursement processes, denials and appeals procedures, third-party payer contracts, HIPAA guidelines, and federal/state healthcare regulations.
• Strong critical thinking, analytical, and problem-solving skills with high attention to detail.
• Excellent organizational, time management, and prioritization abilities.
• Strong written and verbal communication skills.
• Proficiency in Microsoft Office applications (Outlook, Word, Excel) and comfort with electronic workflows.
• Ability to read and interpret EOBs (Explanation of Benefits).