About the role
Job Family: Medical Assistant Travel Required: None Clearance Required: None What You Will Do: Receive, triage, and prioritize denied hospital claims based on timely filing
requirements, financial impact, and payer response deadlines. Conduct root cause analysis to identify clinical, documentation, authorization, or payer‑related reasons for denial. Coordinate with nurse reviewers, coding, utilization management, and revenue cycle teams to determine appeal viability. Assemble and submit complete appeal packets, ensuring inclusion of appropriate clinical documentation and payer‑specific
requirements. Submit appeals via payer portals, secure fax, or mail, and confirm receipt to ensure timely adjudication. Perform systematic appeal/um follow‑up at defined intervals until final claim resolution is achieved. Track denial and appeal activity, maintaining accurate documentation within hospital and payer systems. Identify denial trends and recurring issues and communicate findings to leadership to support process improvement initiatives. Adhere to all hospital policies, payer guidelines, and regulatory
requirements related to claims and appeals processing. What You Will Need: Requires a high school diploma 3-5 years of prior relevant experience in hospital revenue cycle, clinical denials, appeals, utilization management, or medical claims processing, health information management, or a related field. What Would Be
Nice To Have: Associates or Bachelors in healthcare administration, Clinical background or experience working directly with nursing or utilization management teams. Experience with inpatient hospital claims, DRG‑based reimbursement, and payer portals. Strong understanding of payer denial codes, appeal workflows, and hospital billing processes. Excellent organizational, analytical, and written communication skills. Ability to manage multiple accounts simultaneously while meeting strict deadlines #LI-DNI The annual salary range for this position is $49,000.00-$81,000.00.