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Job Description
Accounts Receivable (Denial Specialist)
The Cardiovascular Institute of Florida Location:
Ocala, FL Job Type:
Full-Time | Hybrid Join Our Team! The Cardiovascular Institute is seeking an experienced Accounts Receivable (Denial Specialist) to join our Revenue Cycle team in Ocala, Florida . This position is responsible for ensuring timely and accurate reimbursement by investigating, appealing, and resolving insurance claim denials while supporting the overall financial health of the organization. The ideal candidate possesses a strong understanding of physician practice billing, insurance reimbursement, and denial management, with a commitment to accuracy, accountability, and exceptional service. Position Summary The Accounts Receivable (Denial Specialist) is responsible for the management and resolution of denied, rejected, and underpaid insurance claims. This role works collaboratively with internal departments and insurance payers to identify the root cause of reimbursement issues, submit appeals, and maximize collections while maintaining compliance with payer guidelines and regulatory requirements. Essential Duties and Responsibilities Review and analyze denied, rejected, and underpaid insurance claims. Research denial reasons and determine the appropriate course of action for resolution. Prepare and submit timely insurance appeals and corrected claims. Follow up with Medicare, Medicaid, commercial insurance carriers, managed care organizations, and other third-party payers regarding outstanding accounts. Review Explanation of Benefits (EOBs), Electronic Remittance Advices (ERAs), and payer correspondence to identify reimbursement discrepancies. Investigate coding, authorization, eligibility, registration, and documentation issues contributing to claim denials. Collaborate with Coding, Billing, Patient Access, Clinical Operations, and Provider teams to resolve claim issues. Monitor denial trends and recommend process improvements to reduce future denials. Maintain complete and accurate account documentation within the practice management system. Meet established productivity, quality, and collection performance standards. Ensure compliance with
HIPAA, CMS
regulations, payer policies, and organizational standards. Perform additional revenue cycle duties and special projects as assigned. Minimum Education Qualifications High School Diploma or GED required. Associate degree in Healthcare Administration, Medical Billing, Business Administration, or a related field preferred. Experience Minimum of 2 years of Accounts Receivable or Insurance Denial Management experience in a physician practice or healthcare setting required. Experience working with Medicare, Medicaid, commercial insurance carriers, and managed care organizations required. Cardiology or multispecialty physician practice experience preferred. Knowledge, Skills & Abilities Strong knowledge of healthcare revenue cycle operations and insurance reimbursement processes. Working knowledge of CPT, ICD-10-CM, and HCPCS coding principles. Experience preparing insurance appeals and resolving denied claims. Ability to interpret EOBs, ERAs, payer contracts, and reimbursement methodologies. Strong analytical and critical thinking skills. Excellent attention to detail and organizational skills. Effective verbal and written communication abilities. Ability to prioritize workload and meet established deadlines. Proficiency in Microsoft Office Suite, particularly Outlook and Excel. Experience with electronic health records (EHR) and practice management systems. Why Join The Cardiovascular Institute? At The Cardiovascular Institute, we are committed to delivering exceptional cardiovascular care while fostering a culture of integrity, collaboration, and continuous improvement. Our team members are valued partners in achieving operational excellence and delivering outstanding service to our patients and providers. If you are looking to grow your career with a respected cardiovascular organization dedicated to excellence in patient care and revenue cycle performance, we encourage you to apply. Benefits Competitive Compensation Medical, Dental, and Vision Insurance Employer-Paid Life Insurance Supplemental Insurance Options Paid Time Off (PTO) Paid Holidays 401(k)
Retirement Plan Employee Assistance Program Professional Development Opportunities Benefits:
401(k) 401(k) matching Dental insurance Flexible spending account Health insurance Health savings account Life insurance Paid time off Parental leave Vision insurance Application Question(s): How many years of medical accounts receivable and physician practice billing experience do you have? Do you have cardiology or specialty physician practice experience? Are you able to work on-site/hybrid in Ocala, Florida?
