We are seeking a Denial Appeals Specialist in Brooklyn, NY, to act as a hospital liaison with third-party payers. In this role, you will review denied claims, write appeals, and retrospectively pre-certify Medicaid, Medicare, and private insurance accounts.

Your responsibilities will include conducting utilization chart reviews, analyzing denial rationales, and providing medical necessity appeal services. You will audit patient records for retrospective pre-certification, identify areas for process improvement, and ensure compliance with Medicare guidelines. Additionally, you will draft appeal letters, research relevant regulations, and develop strategies to reduce denials. Timely filing of appeals with Medicare and private insurers is essential.

Schedule: Full Time – Monday through Friday 8:30am – 5:00pm

Compensation: $78,500 – 85,000

Qualifications:

• BA/BS in Health Care Management

• Minimum 5 years of medicine/clinical and/or denial/appeals management/utilization review experience in a health related setting.

Brooklyn is a vibrant and dynamic borough with a rich tapestry of culture, history, and community. Whether you're exploring its iconic landmarks, dining at its world-class restaurants, or immersing yourself in its diverse neighborhoods, Brooklyn offers a truly unique and unforgettable experience.