Senior Denials Management Analyst to support a fast-growing hospital billing project. This on-site role is based at our Birmingham office at 200 Century Park South, with free parking and flexible scheduling options to help you commute outside of peak traffic times. It's an opportunity to make a meaningful difference in hospital financial health - and to grow your career in a stable and respected local organization.
Key Responsibilities
- Coordinate the Denial Management activities for Hospital Based denials from various government and third-party payers.
- Provide reporting support for standard monthly denial reporting and ad-hoc denial report requests.
- Develop a monthly Denial Management MOR report and present it in person to senior management (company and client) during the monthly client meeting.
- Analyze specific payer denials and recommend resolution.
- Communicate with the insurance follow-up team and the appeals team to recommend actions for specific denials.
- Contact insurance payers when appropriate to identify the true nature of the denials
- Identify underpayments on large balance claims and validate the correct reimbursement model that was used for payment.
- A broad understanding of complex revenue cycle management concepts and theories including reimbursement models (MS-DRG, APR-DRG, EAPGs, carveouts, fee schedule hierarchies), CMS Local Coverage Determinations and National Coverage Determinations, Medical Policies, General Medical Coding concepts, extensive understanding of UB-04 claim concepts, among others.
- Escalate complex denial issues to senior management with recommendations for further actions to resolve claim denial issues.
- Coordinate configuration updates in Epic related to denial classification and source/owning departments.
- Monitor payer denials for trends and new denial issues caused by changes in their authorization/pre-cert/notification/referral requirements.
Qualifications
- 8-10 years of experience in hospital denial management or revenue cycle operations
- Bachelor's degree required
- Strong working knowledge of reimbursement models (MS-DRG, APR-DRG, EAPGs, fee schedules) and payer medical policy (LCD/NCD)
- Proficient in UB-04 billing, denial trends analysis, and Epic configuration updates
- Confident communicator with experience presenting data to senior leadership
- Proven ability to work independently, solve complex problems, and lead data-driven decisions
What We Offer
- Competitive salary based on experience
- Performance-based bonus potential
- A professional, mission-driven team in our Birmingham office.
- Free on-site parking and flexible start times to help you avoid peak traffic
- Career growth within a respected, stable healthcare company
Our Recruitment Process
Qualified candidates will receive an email invitation to complete a brief video interview. We value your time and aim to make the process smooth and flexible based on your availability. If you are unable to complete the video interview, please contact us to request alternative interview options.
