Denials and Appeals Specialist

Denials and Appeals Specialist

Accounts Receivable Claims Follow-Up Denial Management

GlyCare is seeking an experiencedDenials and Appeals Specialist to join our growing billing team in Jacksonville Florida.

This position supports a hospital-based medical group operating across multiple states. The primary focus of this role is denial management including researching claim issues determining the appropriate resolution and preparing corrected claims reconsiderations and appeals.

This is an excellent opportunity for someone who enjoys problem-solving takes ownership of accounts through resolution and wants to expand their knowledge of commercial insurance Medicare Medicaid and multi-state physician billing. The position includes structured on-site training ongoing team support and opportunities to gain experience in additional areas of the revenue cycle.

As GlyCare continues to expand this role offers the opportunity to grow professionally and contribute to the development of an evolving revenue cycle department.

What Youll Do

• Manage denied rejected delayed underpaid and unpaid insurance claims.
• Review claim status payer responses account history and supporting documentation to determine the appropriate next steps.
• Contact commercial insurance plans Medicare Medicaid and managed care payers to research and resolve claim issues.
• Correct and resubmit claims when appropriate.
• Prepare and submit reconsiderations corrected claims and formal appeals.
• Research issues involving eligibility coordination of benefits authorization documentation coding provider enrollment claim submission reimbursement and payer processing.
• Review explanations of benefits electronic remittance advice denial messages and payer correspondence.
• Clearly document payer communication follow-up activity and resolution steps.
• Monitor outstanding accounts and complete timely follow-up until each issue is resolved or appropriately escalated.
• Identify recurring payer provider location or claim-processing issues and communicate trends to leadership.
• Use Excel billing-system reports and internal tracking tools to organize work and monitor progress.
• Collaborate with billing credentialing clinical operations providers and leadership to support timely reimbursement and reduce preventable denials.
• Assist patients with billing questions insurance concerns balances or account-related issues professionally and respectfully.
• Support related billing functions including insurance accounts receivable payment research claim corrections patient balance review and limited payment posting as needed.

While denial management is the primary focus of this position the specialist will also provide support in related billing functions as needed. Cross training is intended to strengthen the employees overall revenue cycle knowledge and provide additional professional development opportunities.

What Were Looking For

• At least two years of recent experience in medical billing insurance follow-up accounts receivable denial management payment posting claims processing or a related revenue cycle role.
• Experience in a physician practice hospital-based practice specialty group medical billing company health system or similar healthcare setting.
• Working knowledge of medical billing claim processing and insurance reimbursement.
• Ability to determine why a claim was rejected denied delayed or underpaid and identify the appropriate action.
• Experience working with commercial insurance Medicare Medicaid managed care or other healthcare payers.
• Ability to read and interpret payer correspondence claim status information explanations of benefits and electronic remittance advice.
• Professional communication skills when working with insurance representatives patients providers and internal team members.
• Strong organization documentation time-management and follow-through skills.
• Ability to manage multiple priorities and independently work through billing and reimbursement issues.
• Comfort learning new payer requirements systems workflows and responsibilities.
• Experience using electronic medical record or practice-management software.
• Basic to intermediate Microsoft Excel skills.

Experience in every area listed above is not required. We are looking for someone with a strong medical billing foundation a willingness to learn and the ability to research and work through claim issues with appropriate training and support.

Key Traits for Success

• Persistent and resourceful when researching claim and payer issues.
• Proactive in identifying problems trends and possible solutions.
• Able to work independently while knowing when collaboration or escalation is appropriate.
• Organized and adaptable in a growing healthcare environment.
• Detail-oriented and consistent with account documentation and follow-up.
• Interested in developing a broader understanding of payer requirements and revenue cycle operations.
• Positive dependable and team oriented.
• Motivated by resolving problems rather than simply completing assigned tasks.

Education

A college degree is not required. Relevant hands-on medical billing insurance claims or revenue cycle experience is valued more heavily than formal education.

Professional billing or coding certifications are welcomed but not required.

Compensation and Benefits

Salary: $60000$70000 annually based on relevant experience and qualifications.

GlyCare offers:

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• 401(k) retirement plan with a company match
• Structured on-site training and ongoing team support
• Opportunities to expand your knowledge of multi-state payer requirements and revenue cycle operations

Work Schedule and Location

This is a full-time on-site position located in Jacksonville Florida.

Schedule: Monday through Friday 8:00 a.m.5:00 p.m.

This is not a remote or hybrid position. Applicants must be able to reliably commute to the Jacksonville office.