Hospital Appeal / Denial Analyst

Overview

We are seeking a detail-oriented and experienced Senior Collection / Appeal Representative to join our team. The ideal candidate will have a strong understanding of hospital claim denials, billing, coding, medical terminology and specifically skilled in complex aged claims collections. This role is crucial in ensuring timely collection of outstanding accounts while maintaining positive relationships with clients and healthcare providers.

About Us

ERISA Recovery is a fast-growing company based in Dallas, TX, specializing in the recovery of aged and complex claims using the Federal ERISA appeals process. Our collaborative and innovative team offers an extraordinary opportunity for career growth in the ever-evolving revenue cycle industry. If you're ready to advance your career with a company that values passion, precision, and teamwork, we want to meet you.

Position Overview

We're looking for a Senior Medical Hospital Collections Specialist to join our team. The ideal candidate is highly skilled in navigating denied claims, writing compelling appeals, and driving results in a fast-paced, deadline-oriented environment. This role requires an individual who is self-motivated, detail-oriented, and thrives on collaboration while managing independent tasks with minimal oversight.

Key Responsibilities

• Expertise in processing UB-04 hospital claims with a comprehensive understanding of hospital billing form requirements.
• Strong knowledge of medical terminology, CPT codes, modifiers, and diagnosis codes
• Thorough understanding of the revenue cycle process, including prior authorization, billing, insurance appeals , and hospital collections.
• Extensive experience with payor contracts and claim reimbursement policies.
• Independently review, submit, follow up on, and collect payments for denied hospital claims.
• Ensure denied hospital medical claims are resolved quickly and accurately.
• Communicate professionally and effectively with insurance companies and healthcare providers to expedite claims resolution.
• Draft and submit clear and concise medical appeals aimed at maximizing claim recoveries.
• Collaborate cross-functionally with internal departments and external stakeholders to optimize claim outcomes.
• Adapt and learn new systems and technologies to enhance the claims process.
• Meet daily, weekly, and monthly performance benchmarks to ensure individual and team success.

Desired Skills and Qualifications

Benefits

Schedule

Relocation

ERISA Recovery is an Equal Opportunity Employer

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