Enterprise Denial Analyst | Enterprise Denials

Overview

The 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:

• Research 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 elevate 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.

• 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.

• 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

Employees in this position will not operate vehicles for an assigned business purpose.

• None required