Lakeland Regional Health-Florida · 1 day ago
AR Follow Up Denials Specialist - Denial & Appeals
Lakeland, FL
Full-time
Onsite
Entry, Mid Level
$17.84/hr - $20.53/hr
2+ years expLakeland Regional Health is a leading medical center located in Central Florida, dedicated to providing high-quality care to its diverse patient population. The AR Follow Up Denials Specialist is responsible for collecting payments for outstanding hospital claims, managing accounts, researching denials, and ensuring compliance with federal regulations and insurance guidelines.
FitnessHealth CareNon Profit
Responsibilities
Fosters an inclusive and engaged environment through teamwork and collaboration
Ensures patients and families have the best possible experiences across the continuum of care
Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created
Behaves in a mindful manner focused on self, patient, visitor, and team safety
Demonstrates accountability and commitment to quality work
Participates actively in process improvement and adoption of standard work
Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities
Knows and adheres to organizational and department policies and procedures
Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives
Responsible for all aspects of follow up and collections on accounts. This includes making outbound calls to payers and accessing payer websites
Collect payments for outstanding claims and ensure payments received are reconciled correctly
Confirm the claim expected reimbursement information to ensure claims are paid correctly. Follows department’s process for follow up on underpayments/overpayments
Research and prepare responses for payor requests for additional information or documentation
Submits corrected claim rebill requests to the PFS Billing team when necessary to send to the insurance payer with correct information and ensures payment is received and claims are paid per contract
Research denials and works with other departments such as Coding, Billing, CDM, UM, ect. to resolve denial
Submits the insurance reconsideration/appeals with supporting documentation in a timely manner and follow up with insurance to ensure receipt and processing. Follows insurance payer claims and appeals timely filing guidelines
Communicate clearly and professionally, in both written and verbal manners with internal personnel, payors, providers, patients, and other authorized representatives in regards to outstanding balances
Responsible for adequately working correspondence timely and efficiently (including EOBs, RA’s, denial letters)
Maintain knowledge of current government and carrier regulations, policies, manuals relevant to the industry
Identify and report trends in carrier payments and denials, which includes documentation of actions taken to resolve issues. Follows internal escalation process when necessary
Identify complex and aged claims issues and follows internal escalation process appropriately
Maintain patient confidentiality and privacy; adheres to HIPAA standards
Organizes job functions and work assignments to be able to effectively complete assignments within established time frames
Must meet department Productivity Guidelines. Works with all areas of the department to assure maximum productivity. Utilizes the PFS Productivity tracker
Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities
Other duties, responsibilities, and activities may change or be assigned at any time with or without notice
Qualification
Required
Four years general Patient Accounting experience including understanding of Managed Care contracts and claims analysis
Understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payers and their guidelines
Knowledge of healthcare rules and regulations
An overall understanding of the appeals processes through completion
Ability to read/interpret EOB's
Working knowledge of Word, Excel or other Microsoft applications
Good analytical skills for problem solving, typing of 40 WPM and data entry
Knowledge of Accounting Principles; analytical mathematical skills, professional customer service communication skills
Demonstrates accuracy and thoroughness; Meets productivity standards; Completes work in timely manner
Consistently shows ability to recognize and deal with priorities
Adapts to changes in the work environment; Able to deal with frequent change, delays, or unexpected events
Knowledge of HIPAA guidelines
Demonstrates good judgment and reasoning when investigating and solving problems
Good critical thinking skills
Ability to prioritize and manage time effectively
High School or Equivalent
Two years general patient accounting experience
Preferred
Four years general patient accounting experience
Experience working with and general understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payors
AAHAM or HFMA certification
Associate Degree
Business or Healthcare Administration
Ability to prioritize and manage time effectively
Company
Lakeland Regional Health-Florida
At Lakeland Regional Health, we place people at the heart of all we do.
5001-10000 employees
H1B Sponsorship
Lakeland Regional Health-Florida has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (5)
Funding
Current Stage
Late StageLeadership Team
Stacy Bolton
Vice President - CTO Chief Technology Officer
Lance Green, CPA
EVP/Chief Financial Officer
Recent News
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