Denials Prevention Specialist PRN

The Specialist is responsible for identifying, analyzing, and resolving claim denials across the entire revenue cycle to ensure optimal reimbursement and compliance with payer regulations. This role requires in-depth knowledge of healthcare revenue cycle processes, HIM coding practices, and proficiency in multiple electronic systems and software tools. The specialist serves as a key liaison between coding, billing, utilization review, case management, and payer relations to reduce denials and improve revenue leakage.

You will:

• 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.

What you will bring to the table:

• Associate's or Bachelor's degree in Health Information Management, Health Administration, or related field required.
• RHIT, RHIA, CCS, or CPC certification preferred.
• Minimum 3-5 years of experience in healthcare revenue cycle with focus on denials management.
• Strong knowledge of the entire revenue cycle including registration, coding, billing, and collections.
• Proficient in Microsoft Office Suite (especially Excel), EHRs, claims editing software, and data analytics tools.
• Exceptional analytical, organizational, and communication skills.
• Ability to interpret Explanation of Benefits (EOBs), Remittance Advice (RA), and payer policies.
• Demonstrated ability to work independently and within a team in a fast-paced environment.

Bonus points if:

• Previous experience with revenue integrity functions in a hospital or large physician group setting.
• Familiarity with DRG and APC reimbursement methodologies.
• Knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding systems.We are committed to building a diverse team of Datavanters who are all responsible for stewarding a high-performance culture in which all Datavanters belong and thrive. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.

Our compensation philosophy is to be externally competitive, internally fair, and not win or lose on compensation. Salary ranges for this position are developed with the support of benchmarks and industry best practices.

We're building a high-growth, high-autonomy culture. We rely less on job titles and more on cultivating an environment where anyone can contribute, the best ideas win, and personal growth is driven by expanding impact. The range posted is for a given job title, which can include multiple levels. Individual rates for the same job title may differ based on their level, responsibilities, skills, and experience for a specific job. The estimated salary range for this role is $32.00 - $45.00.