Revenue Cycle Specialist- Denial Management

Revenue Cycle Specialist- Denial Management at United Theranostics Revenue Cycle Specialist- Denial Management at United Theranostics in Cabin John, Maryland Posted in 2 days ago.

Type:

full-time

Job Description:

United Theranostics is redefining the clinical practice of molecular imaging and radiopharmaceutical therapy from available to meaningful accessibility. Our network of nuclear medicine facilities specializes in personalized cancer treatment, combining advanced diagnostics with targeted radiopharmaceutical therapies. We bring the latest in precision medicine to patients in their local communities.

POSITION OVERVIEW

The Revenue Cycle Specialist supports the daily operations of the revenue cycle with a strong focus on denial management. Duties include reviewing denied insurance claims, analyzing payer policies for accuracy, writing strong and persuasive appeals, and prioritizing aged denials to ensure timely and appropriate reimbursement. The Revenue Cycle Specialist identified payer denial trends, builds compelling cases for overturning denials, and advocate effectively for proper claim payment.

RESPONSIBILITIES

Review denied insurance claims for accuracy, ensuring all necessary documentation and coding were properly submitted. Research insurance payer policies and guidelines to verify the validity of denials and determine the appropriate course of action. Prepare, write, and submit persuasive, evidence-based appeals in a timely and effective manner to overturn inappropriate denials. Prioritize and manage aged and high-risk denials to expedite resolution and maximize reimbursement. Identify patterns and trends in payer denials, report findings, and proactively recommend strategies to prevent future denials. Collaborate with the billing team and third-party vendors to monitor and follow up on outstanding claims and appeal statuses. Investigate claim issues thoroughly, address root causes, and escalate complex issues when necessary. Maintain accurate and detailed records of all denial management activities, including appeal submissions and outcomes. Communicate professionally and effectively with payers, patients, and internal teams regarding claim status, billing inquiries, and account resolutions. Support the Revenue Cycle Manager by gathering denial data, assisting with reporting, and participating in troubleshooting initiatives. Assist with maintaining payer-related documentation, including updates to payer policies, appeal templates, and denial management workflows. Participate in process improvement efforts to strengthen revenue cycle performance and prevent recurring denials. Perform other billing and duties as assigned to support the overall goals of the revenue cycle team.

EDUCATION & REQUIREMENTS

Bachelor's degree or equivalent experience 3+ years of experience in healthcare revenue cycle management, medical billing, or a related area. Familiarity with billing or claims management software and basic proficiency in Microsoft Office Suite. Excellent communication, attention to detail, and organizational skills. Ability to work collaboratively with teams and handle patient interactions professionally.