Revascent

Position Summary

The Denial Management Specialist is responsible for reviewing, analyzing, and resolving payer denials. The role focuses on root-cause identification, appeal submission, and prevention strategies to improve first-pass acceptance and revenue recovery.

Key Responsibilities

Denial Review & Resolution

• Analyze denial codes, EOBs, and payer correspondence.
• Determine corrective actions: corrected claim, appeal, or documentation request.
• Prepare appeal packets including clinical notes, letters, and supporting evidence.

Root-Cause Analysis

• Categorize denials (coding, eligibility, authorization, bundling, documentation).
• Identify trends and escalate repeat issues to team leadership.

Tracking & Reporting

• Maintain denial logs with actions, outcomes, and recovery amounts.
• Provide weekly denial summary reports and recommendations.

Cross-Functional Collaboration

• Work with coders, billers, and charge entry to correct workflows.
• Provide education on recurring denial patterns.

Qualifications

Required

• 2+ years in denial management or AR follow-up.
• Eye experience preferred 
• Knowledge of payer policies, appeal timelines, and CARC/RARC codes.
• Strong analytical and written communication skills.

Preferred

• Experience with specialty care denials (especially retina).
• Familiarity with payer portals and electronic appeals.
• Familiarity with PM/EHR systems (e.g., Healthpac, NextTech, ModMed, ECW, Athena, MedInformatics, AdvancedMD).

Core Competencies

• Analytical problem-solving
• Written communication
• Documentation review
• Persistence and follow-through
• Organization
• Attention to detail

Work Environment

• Remote or hybrid based on company structure.
• May require occasional payer calls or joint review meetings.