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Denials, credit / refund analyst

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UC San Diego

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Location:
United States

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Category:
Finance

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Contract Type:
Not provided

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Salary:

79200.00 - 143400.00 USD / Year ▼
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Job Description:

The Denials, Credit/Refund Analyst role works in partnership with department leadership, vendors, internal and external customers to resolve and/or improve hospital patient account revenues related to hospital billing and collections.

Job Responsibility:

  • Works in partnership with department leadership, vendors, internal and external customers to resolve and/or improve hospital patient account revenues related to hospital billing and collections
  • Provides team support as a hospital billing and follow up subject matter expert performing patient account audits, supporting team training tasks, participate and present root-cause analysis in account receivable workgroups
  • Performs department data analytics in support of trending, root cause analysis, and proactive identification of hospital accounts receivable risks
  • Performs advanced interpretation of complex hospital commercial, managed care, and government payer contracts
  • Presents findings and recommendations to Revenue Cycle leadership
  • Monitors and evaluates insurance company payer guideline changes
  • Analyze and present findings of hospital patient account system workflow and/or claim adjudication issues
  • Create, support, and partner in solution design for system tickets supporting hospital “clean claim” submissions and workflow optimization
  • In collaboration with department leadership, develop hospital account data reports required for accounts receivable analysis
  • Provide department administrative support creating and gathering data reports, insurance or vendor correspondence
  • co-facilitate team group meetings related to insurance claim processing and/or workflow changes
  • Participate in development and delivery of hospital billing and follow up training and workflows

Requirements:

  • Seven (7) years of related experience, education/training, OR a Bachelor’s degree in related area plus three years of related experience/training
  • Thorough knowledge of the practices, procedures, and concepts of the healthcare revenue cycle and its component operations
  • Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and other tools and techniques involved with measuring and analyzing the revenue cycle
  • Detail oriented, with proven ability to effectively manage time, see tasks and projects through to completion, organize competing priorities, and effectively address complex, urgent issues as they arise
  • Strong skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management
  • Strong communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner
  • Strong analytical and problem-solving skills
  • Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment
  • Proven ability to work with managers, serving as a technical resource
  • Must be able to work various hours and locations based on business needs
  • Employment is subject to a criminal background check and pre-employment physical

Nice to have:

  • EPIC experience
  • Experience performing medical record review and drafting hospital-level appeals
  • Experience evaluating payer refund request and drafting formal refund denial/acceptance determinations
  • Hospital Billing, Credit/Refunds, and follow-up tasks (including follow-up WQs) experience
  • Working knowledge of hospital commercial contracts, billing and coding guidelines
  • Proven experience performing hospital commercial contracts and billing guidelines
  • Proven experience auditing hospital patient accounts as it pertains to Revenue Cycle
  • Experience in training others
  • Strong organization and time management stills to support patient accounting daily operations

Additional Information:

Job Posted:
January 22, 2026

Expiration:
February 04, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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