Denials and Appeals Specialist
hace 8 días
Jacksonville
Job Description Denials and Appeals Specialist Accounts Receivable | Claims Follow-Up | Denial Management GlyCare is seeking an experienced Denials 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 You’ll 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 employee’s overall revenue cycle knowledge and provide additional professional development opportunities. What We’re 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: $60,000–$70,000 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.
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