Technical Denials Specialist

Summary

The Technical Denials Specialist plays a critical role in the health system’s revenue cycle operations by managing and appealing payer denials, with a strong focus on medical necessity, authorization, and eligibility issues. This position is responsible for identifying root causes, preparing and submitting appeals, and providing actionable feedback to key departments such as Patient Access and Registration. Through data analysis, reporting, and cross-functional collaboration, this role helps drive improvements that reduce denials and ensure optimal reimbursement.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Principal Duties and Responsibilities

• Manages the end-to-end process for claim denials and appeals, including receipt, analysis, documentation, submission, and resolution with third-party payers.
• Handles denials related to eligibility, medical necessity, prior authorization, non-coverage, and coding errors.
• Performs root cause analysis to identify trends in denials and collaborates with internal stakeholders, particularly Patient Access and Registration, to provide feedback and recommend process improvements.
• Submits timely and accurate appeals with appropriate supporting documentation and in accordance with payer guidelines and timelines.
• Prepares and distributes monthly denial trend reports and dashboards to Revenue Cycle leadership, highlighting key findings, financial impacts, and suggested corrective actions.
• Works closely with Revenue Cycle leadership to develop and implement preventative strategies aimed at reducing eligibility and authorization-related denials.
• Recommends enhancements to claim edits, workflows, or registration practices to reduce recurring denial types.
• Reviews payer correspondence and authorization requirements to assess financial risk and initiate retro-authorization requests when appropriate.
• Maintains accurate records of all appeals activity and correspondence, ensuring compliance with internal policies and external regulations.
• Ensures adherence to HIPAA, fraud and abuse laws, and organizational policies related to data security and confidentiality.
• Maintains effective communication with payers and internal stakeholders, demonstrating professionalism, urgency, and accountability.
• Engages in continuous learning to stay updated on payer requirements, industry changes, and revenue cycle best practices.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor’s degree (required) preferably in Health Administration, Business, Public Health, or a related field.
• Minimum of 3 years of experience in hospital revenue cycle operations, with emphasis on denial management and appeals.

?Knowledge & Skills

• Strong understanding of hospital registration, eligibility verification, and payer authorization processes.
• Experience analyzing denial trends and providing actionable insights to cross-functional teams.
• Proficient in Microsoft Office, hospital billing systems, and electronic health records (EHR).
• Exceptional analytical, organizational, and written communication skills.
• Ability to work independently, manage competing priorities, and collaborate effectively with clinical and non-clinical departments.

Working Conditions

• Works in an office environment.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.