Events

• Monitor and manage denials throughout the entire revenue cycle, including registration, eligibility, coding, billing, and medical necessity.
• Analyze denial trends and root causes using data analytics tools and electronic health record (EHR) systems.
• Collaborate with internal departments (HIM, billing, case management, patient access) to investigate and resolve complex denials.
• Utilize in-depth computer skills to navigate and extract data from multiple systems such as Epic, Cerner, Meditech, 3M, Optum, SSI, Availity, and payer portals.
• Submit and track appeals with payers, ensuring all documentation and deadlines are met.
• Prepare and present regular reports on denial metrics, recovery efforts, and opportunities for improvement.
• Stay current on payer policy changes, CMS updates, and healthcare regulations affecting claim adjudication.
• Serve as a key liaison between coding, billing, utilization review, case management, and payer relations to reduce denials and improve revenue leakage.

Denials Prevention Specialist

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Employee Experience & Events Intern