Overview Work remotely while using your denial management expertise to make a direct impact on healthcare operations. 💻 Work Style: Remote 📍 Location Requirement: Must reside in an approved state (FL, GA, PA, NC, SC, T…
Overview Help ensure providers are ready to deliver exceptional patient care by supporting credentialing, enrollment, and regulatory compliance across the UF Health Shands system. 💻 Work Style: Onsite, with hybrid flexi…
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Requisition No: 879028 Agency: Agency for Persons with Disabilities Working Title: SENIOR LICENSED PRACTICAL NURSE - 67036102 Pay Plan: Career Service Position Number: 67036102 Salary: $1,996.29 - $2,188.93 BIWEEKLY Post…
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Full-time
high school, professional certificate
Posted 29d ago
Apply by Jun 28
~40 hrs/week
Remote in Florida, United States, Georgia, United States, North Carolina, United States, Pennsylvania, United States
Responsibilities
The analyst manages clinical denials by performing claim resubmissions, authorization verification, and appeals to optimize reimbursement outcomes. They also analyze denial trends and educate departments on coding and billing practices to ensure regulatory compliance.
Requirements
Candidates must possess a High School Diploma or GED and a valid coding certification such as CPC, COC, RHIT, RHIA, or CCS. Additionally, 1–2 years of experience in both medical coding and denial management or insurance-related roles is required.
Full job description
Overview
Work remotely while using your denial management expertise to make a direct impact on healthcare operations.
💻 Work Style: Remote 📍 Location Requirement: Must reside in an approved state (FL, GA, PA, NC, SC, TN, or TX) 🕒 FTE: Full-Time (1.0 FTE)
Responsible for maintaining low denial rates and optimizing reimbursement across the enterprise by ensuring high coding standards and effective denial management practices. Leads and supports initiatives to improve coding accuracy, reimbursement outcomes, and appeal turnaround times.
Performs in-depth analysis of denial trends, including Epic system edits, coding validation, Charge Description Master (CDM) processes, authorization trends, and payer denials. Identifies opportunities for performance improvement and implements strategies to enhance revenue cycle outcomes.
Educates departments on appropriate charging, billing, and coding practices to ensure regulatory compliance. Collaborates with Managed Care, Compliance, and operational teams to resolve complex issues with departments and payers, driving sustainable improvements in reimbursement and denial prevention.
Responsibilities
Key Responsibilities:
Manages clinical denials from assigned work queues, including claim resubmissions, authorization verification, payer reprocessing, reconsiderations, and appeals
Partners closely with Managed Care and payers to reduce denials and improve reimbursement outcomes
Analyzes denial trends and develops recommendations to improve coding accuracy and documentation practices
Meets established productivity and accuracy standards, including reviewing approximately 30 accounts per day with a 98% accuracy rate
Applies coding guidelines (NCCI, ICD-10, CPT, HCPCS, CMS) to accurately review, code, and correct accounts
Collaborates with department managers to track, report, and resolve denials, including participating in audits and compliance reviews
Identifies root causes of denials, tracks trends, and escalates findings to leadership for follow-up and process improvement
Works across multiple payer work queues, including Medicare, Medicaid, government, and commercial payers
Research denials related to authorization, medical necessity, non-covered services, coding, and billing issues, ensuring timely resolution and appeal submission
Prepares and submits detailed, well-supported reconsiderations and appeals based on medical record review and payer requirements
Monitors payer communications and policy updates to identify risks impacting reimbursement and authorization requirements
Reviews and corrects coding, including modifier usage, diagnosis sequencing, and compliance with coding guidelines
Reviews and adjusts charges as needed based on documentation, billing, and regulatory standards
Educates departments on denial prevention strategies, including improvements in coding, charging, and authorization processes
Qualifications
Minimum Qualifications:
High School Diploma or GED required
One of the following coding certifications required: CPC, COC, RHIT, RHIA, or CCS
1–2 years of coding experience, along with 1–2 years of denial management and/or insurance-related experience
University of Florida Health is a world-class academic health center in Florida, encompassing hospitals, physician practices, colleges, centers, institutes, programs and services across northeast and north-central Florida.
UF Health represents the shared vision and commitment to patient care excellence of more than 22,000 employees of the University of Florida Health Science Center and UF Health Shands health care system.
Offices: 1600 SW Archer Rd, Gainesville, FL 32608, US · 1515 SW Archer Road, Gainesville, FL 32608, US · 1600 SW Archer Road, Gainesville, FL 32608, US · 655 West 8th Street, Jacksonville, FL 32209, US
How many Healthcare jobs are open in Gainesville, FL right now?
There are currently 845 open healthcare positions in Gainesville, FL listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Gainesville, FL?
Companies currently hiring include UF Health, SIMEDHealth, Florida Department of Agriculture and Consumer Services, LifeSouth Community Blood Centers, Compass Group, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Gainesville, FL?
Yes — 42 of the 845 open healthcare positions offer remote or hybrid work (19 remote, 23 hybrid).
How do I apply for Healthcare jobs in Gainesville, FL?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.