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Denials Manager Jobs in Florida (NOW HIRING)

Dr. MobiCare

Revenue Cycle Manager Onsite

Miami, FL · On-site

$90K - $110K/yr

Revenue Cycle Manager - OnsiteWound Care Division | North Miami, FL Location: North Miami, Florida ... Identify trends in denials, underpayments, rejections, and billing errors. * Develop and implement ...

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Denials Manager information

What is a denials manager?

A Denials Manager is a healthcare professional responsible for overseeing and managing the process of claim denials from insurance companies. Their primary role is to identify the causes of denied claims, implement strategies to reduce future denials, and ensure timely resolution and appeal of denied claims to maximize revenue for healthcare organizations. Denials Managers often collaborate with billing, coding, and clinical staff to ensure compliance with payer requirements and improve the overall reimbursement process. They play a crucial role in maintaining the financial health of medical practices or hospitals by minimizing lost revenue due to claim denials.

What are the key skills and qualifications needed to thrive as a denials manager?

To thrive as a Denials Manager, you need a deep understanding of medical billing, coding, insurance processes, and healthcare regulations, usually supported by a degree in healthcare administration or a related field. Familiarity with revenue cycle management systems, electronic health records (EHRs), and data analytics tools is essential, and certification like Certified Revenue Cycle Representative (CRCR) can be advantageous. Strong analytical thinking, problem-solving, and communication skills help in effectively leading teams and negotiating appeals with payers. These skills are critical for minimizing revenue loss, ensuring compliance, and optimizing reimbursement processes within healthcare organizations.

What are some common challenges faced by denials managers, and how can they effectively address them?

Denials Managers often encounter challenges such as identifying root causes of claim denials, staying updated with changing payer policies, and coordinating between billing, coding, and clinical teams. To address these challenges, Denials Managers typically implement robust tracking systems, conduct regular staff training, and foster open communication across departments. Proactively analyzing denial trends and collaborating on process improvements are key strategies to reduce future denials and enhance overall revenue cycle performance.

What is the difference between Denials Manager vs Claims Supervisor?

AspectDenials ManagerClaims Supervisor
CredentialsTypically requires healthcare administration, billing, or coding certificationsOften requires similar certifications, with additional supervisory or management training
Work EnvironmentManages denial appeals, reviews claim rejections, collaborates with billing and coding teamsOversees claims processing, supervises claims staff, ensures compliance with policies
Industry UsageCommon in healthcare, insurance, and hospital settingsCommon in healthcare organizations, insurance companies, and billing departments

While both roles focus on claims processing, the Denials Manager specializes in managing claim denials and appeals, whereas the Claims Supervisor oversees the entire claims process and staff. Both positions require healthcare billing knowledge and certification, but their primary responsibilities differ in scope and focus.

What are popular job titles related to Denials Manager jobs in Florida?

For Denials Manager jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Denials Manager jobs in Florida look for?

The top searched job categories for Denials Manager jobs in Florida are:

What cities in Florida are hiring for Denials Manager jobs?

Cities in Florida with the most Denials Manager job openings:

Denials Manager jobs near you

Denial Recovery Analyst | Enterprise Denials

UF Health

Saint Johns, FL • Remote

Full-time

Re-posted 25 days ago

Job description

Overview

Work remotely while using your denial management expertise to make a direct impact on healthcare operations.

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???? Location Requirement: Must reside in Florida or Georgia
???? FTE: Full-Time (1.0 FTE)

Responsible for reviewing technical denial claims and submitting reconsiderations and appeals to ensure accurate and timely reimbursement. Optimizes financial performance within the revenue cycle by maintaining low denial rates and maximizing recovery across the enterprise.

Conducts root cause analysis of denied payments through comprehensive review of patient encounters, payer contracts, historical denial trends, and appeal outcomes. Maintains strong relationships with third-party payers, responding to inquiries, disputes, and correspondence.

Collaborates with Enterprise Technical Denial Assistance leadership and Managed Care to escalate and resolve complex denial issues while ensuring compliance with state and federal regulations. Serves as a subject matter expert in denial management, partnering with revenue cycle teams to implement best practices that improve reimbursement and reduce organizational write-offs.


Responsibilities

Key Responsibilities

  • Identify, prioritize, and resolve denied claims, including initiating timely appeals and reconsiderations.
  • Interpret and apply payer contract terms to ensure accurate claim resolution and reimbursement.
  • Conduct internal and external correspondence clearly, professionally, and in compliance with organizational standards.
  • Review and take appropriate action on EOBs, denial letters, appeal determinations, and documentation requests in a timely manner.
  • Meet productivity and quality standards, including managing an average of 60 accounts per day while maintaining a 98% accuracy rate.
  • Manage and work multiple payer workqueues, including Medicare, Medicaid, government, commercial, and Medicare Advantage plans.
  • Research and resolve denials related to eligibility, registration, billing errors, missing information, authorizations, and documentation requests.
  • Initiate, track, and follow up on appeals to prevent timely filing denials and maximize reimbursement opportunities.
  • Evaluate accounts and drive resolution using remittance advice, denial codes, payer portals, and payer communications.
  • Identify payer-specific denial trends and escalate findings to leadership with actionable recommendations for root cause analysis.
  • Collaborate with coding, billing, clinical, and revenue cycle teams to improve workflows and reduce future denials.
  • Review payer policies, reimbursement guidelines, and communications to remain current on regulatory and industry changes.
  • Proactively identify and resolve at-risk accounts receivable to minimize revenue loss and ensure compliance with contractual deadlines.
  • Maintain detailed account documentation and ensure all actions are accurately recorded within designated systems.
  • Support organizational revenue integrity initiatives through denial prevention, reimbursement optimization, and process improvement efforts.
  • Serve as a subject matter resource for denial resolution, payer requirements, and reimbursement best practices.
 

Qualifications

Minimum Qualifications

• High School Diploma or GED required

• Minimum of four (4) years of experience in billing, insurance follow-up, collections, or denial management within a hospital or clinical setting

Preferred Qualifications

• Associate’s degree or higher in a health or business-related field

• Experience in coding, medical record review, auditing, or insurance-related functions

• Experience supporting data governance and security policies

• Strong skills in report and dashboard development

• Ability to monitor BI tools and recommend process improvements

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