The Professional Denials Coordinator will work on targeted insurance denials to improve collections and reduce open balances. They will deal with inpatient notices of admission, authorizations, and subsequent denials.
Responsibilities
Defend and appeal claims, including researching root cause, collecting required information, adjusting the account as necessary, resubmitting claims and all appropriate follow up activities.
Submits requests to clarify clinical documentation for accurate coding of denials.
Works with Denials Analyst and Underpayments Coordinator to call attention to areas of opportunity or system/process errors.
Virtual Utilization Review Specialist with at least 1 year Denials Management experience to join our team.
Compensation
Salary Range: $63,100 - $94,650 annually, dependent upon experience, education, certifications, and overall qualifications.
Responsibilities
Utilizes proactive triggers (diagnoses, cost criteria, and complications) to identify potential over/under utilization of services
Initiates appropriate referral to physician advisor in a timely manner
Understands proper utilization of health care resources and assists with identifying barriers to patient progress and collaborates with the interdisciplinary team
Collaborates with financial clearance center, patient access, financial counselors and/or business office regarding billing issues related to third party payers
Conducts medical necessity review of all admissions. Utilizes approved clinical review criteria to determine medical necessity for admissions including appropriate patient status and continued stay reviews, possibly from an offsite location
Requirements
Bachelor's Degree or equivalent experience
Specialty/Major: Nursing or related field
Nice to have: Utilization review/discharge planning experience
Nice to have: Recent experience or working knowledge of medical necessity review criteria
Nice to have: Current working knowledge of quality improvement processes
The Revenue Cycle Specialist - Self Pay is responsible for performing collection follow-up on outstanding insurance balances, identifying claim issues, and ensuring timely resolution in compliance with government and managed care contract terms.
Responsibilities
Performs follow-up on outstanding insurance balances within the required timeframe, obtaining payment confirmation or required documentation.
Documents all actions taken on accounts within the appropriate system, ensuring a clear and traceable resolution process.
Makes the required number of outbound calls to insurance payers while maintaining professional and courteous communication.
Handles and resolves incoming correspondence within five days of receipt, updating the system with relevant information.
Analyzes assigned accounts using AS400, Meditech, Accurint, Cerner, directory assistance, and credit reports to maximize collection efforts.
Requirements
H.S. Diploma or GED required
Associate Degree in Business, Finance, Healthcare Administration, or a related field preferred
Nice to have: experience working with insurance follow-up
Lead performance intelligence, operational analytics, and continuous improvement for the Revenue Cycle Management (RCM) Services organization, translating reliable data into measurable operational and financial results.
This role focuses on resolving claim denials, managing appeals, identifying reimbursement discrepancies, and helping improve claims processes to support timely and accurate payments.
Responsibilities
Review, resolve, and track assigned claim denials and appeals
Identify recurring denial trends and support prevention efforts
Review payment discrepancies against payer contracts and reimbursement guidelines
Follow up on underpayments and pursue appropriate reimbursement recovery
Communicate unresolved payment issues and trends to leadership
Requirements
High school diploma or equivalent
Associate degree or coursework in healthcare administration, business, medical billing, or a related field
Nice to have: Critical access hospital billing experience
Nice to have: Rural health clinic billing experience
Nice to have: Revenue cycle or billing certification
Lead performance intelligence, operational analytics, and continuous improvement for the Revenue Cycle Management (RCM) Services organization.
Compensation
The target base compensation for this position is $80,000 to $90,000 USD year in most US locations.
Responsibilities
Own standardized RCM KPI definitions, data sources, targets, controls, and reporting for days in AR, AR aging, clean claim rate, first-pass resolution, denial and rejection rates, net collection rate, charge lag, posting timeliness, and other core measures.
Establish independent, timely visibility into transaction volumes, work queues, processing status, productivity, quality, and backlog across internal teams and BPO partners.
Deliver actionable client-, portfolio-, and vendor-level dashboards, operating reviews, trend analysis, root-cause findings, and recommended actions.
Lead prioritized, cross-functional process improvement initiatives across charge capture, claims, denials, AR follow-up, payment posting, onboarding, and credentialing/enrollment handoffs.
Partner with the Vendor Manager to define, validate, and report vendor SLAs, transaction volumes, productivity, turnaround time, accuracy, and quality measures.
Requirements
Nice to have: Multi-client RCM services organization experience
Nice to have: EHR/PM systems familiarity
Nice to have: Clearinghouses familiarity
Revenue Cycle Managed Services - Director of Patient Financial Services (PFS)
The Director of AR Resolution will lead managed services operations, focusing on denials management, team leadership, and driving cash flow across US and nearshore teams.
Locations (2)
United States
Mexico
Compensation
salary range of $180,000-260,000
Responsibilities
Spehead root-cause analysis for claim denials and underpayments
Manage and lead team operations
Lead escalations and negotiations with commercial and government payers
Develop comprehensive reports on performance and forecast cash collections
Partner with other Revenue Cycle teams (Coding, Patient Access, etc.) to resolve systemic issues
Requirements
Bachelor's degree in Healthcare Administration
Business Administration
Finance
Nice to have: Master's degree
Nice to have: 3rd party Managed Services experience
Lead and manage revenue cycle improvement engagements in Epic environments, driving AR reduction, cash acceleration, and payer yield improvement for healthcare organizations.
Compensation
This role has a salary range of $125,000-200,000.
Responsibilities
Manage revenue cycle improvement engagements
Lead complex revenue cycle operational transformation engagements
Assess, redesign, and optimize back-end revenue cycle workflows
Identify opportunities to improve revenue integrity
Partner with client stakeholders to align back-end operations with Epic
The target base compensation for this position is $80,000 to $90,000 USD year in most US locations.
Responsibilities
Own standardized RCM KPI definitions, data sources, targets, controls, and reporting for days in AR, AR aging, clean claim rate, first-pass resolution, denial and rejection rates, net collection rate, charge lag, posting timeliness.
Establish independent, timely visibility into transaction volumes, work queues, processing status, productivity, quality, and backlog across internal teams and BPO partners.
Deliver actionable client-, portfolio-, and vendor-level dashboards, operating reviews, trend analysis, root-cause findings, and recommended actions.
Lead prioritized, cross-functional process improvement initiatives across charge capture, claims, denials, AR follow-up, payment posting, onboarding, and credentialing/enrollment handoffs.
Partner with the Vendor Manager to define, validate, and report vendor SLAs, transaction volumes, productivity, turnaround time, accuracy, and quality measures.
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