The Denial Management Analyst manages disputed or denied claims by analyzing medical records and payer policies to recover reimbursements in a hospital setting. Reviews and responds to payer audits. Ensures accurate ICD-10 coding, analyzes denial and audit trends to identify root causes, and coordinates appeals through documentation, contract reviews, and payer negotiations. The analyst supports process improvements, tracks appeals, and collaborates with clinical and revenue teams to efficiently review and resolve claim denials. Follows payer-specific rules, federal and state regulations, and industry trends under limited supervision.
The University of Texas at San Antonio (UT San Antonio) is a nationally recognized, top-tier public research university that unites the power of higher education, biomedical discovery and healthcare within one visionary institution. As the third-largest research university in Texas and a Carnegie R1-designated institution, UT San Antonio is a model of access and excellence - advancing knowledge, social mobility and public health across South Texas and beyond. UT San Antonio serves approximately 42,000 students in 320 academic programs spanning science, engineering, medicine, health, liberal arts, AI, cybersecurity, business, education and more. With 17,000 faculty and staff, UT San Antonio has been recognized by Forbes as one of America's Best Employers for Company Culture.
Benefits Overview
UT Health San Antonio offers an excellent benefits package for its employees. Employees who work at least 20 hours a week, with an appointment of at least 4.5 months, are eligible for benefits.
Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas. Family members can be added to the plan through payroll deduction. Employees and their dependents can also receive discounted copays and coinsurance when using UT Health Physicians, a network of 800 premier physicians including more than 100 specialists. Employees receive $50,000 of group term life insurance and $50,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates.
Dental - Three dental insurance plan options are available for employees and their families through Delta Dental Insurance Company, two PPOs and one dental HMO plan. Both PPO plans allow employees to choose any licensed dentist.
Vision - Fully insured Vision Care benefits are offered by Superior Vision Services. Two vision plan options that offer either standard or enhanced vision benefits.
Disability - Employees can enroll in the Disability Insurance which provides income if a non-work related illness or injury prevents you from working.
FSAs - Employees can enroll in flexible spending accounts (FSAs) to set aside money from earnings before taxes for qualifying dependent day care expenses or out-of-pocket health care expenses.
Retirement - Employees are eligible for either the Teacher Retirement System (TRS) or the Optional Retirement Plan (ORP). TRS is a defined benefit retirement plan which UT Health matches employee contributions. ORP is for eligible faculty staff employees. Voluntary retirement programs are also available to invest before- or after-tax dollars with the choice of five quality retirement plan providers.
Time Off - A generous leave program offers multiple paid leave options:
- Front-loaded Paid Time Off: 128 to 208 hours (16 to 26 days) of Paid Time Off based on years of service, given at the start of each fiscal year. PTO may be prorated in year one based on date of hire.
- Extended Illness Bank: 8 hours (1 day) accrued per month which can be used for illness or injury after one day of Paid Time Off is taken.
- Paid Family Leave: Up to 240 hours (6 weeks) to care for a spouse, child, or parent after 6 months of consecutive employment.
- Holidays: 12 set paid holidays each year.
Discounts - Employees enjoy a range of discounts on services, tickets, and gym membership.
EEO Statement
UT Health San Antonio is an equal employment opportunity and affirmative action employer. It is our policy to promote and ensure equal employment opportunity for all individuals without regard to race, color, religion, sex, gender identity, national origin, age, sexual orientation, disability, or veteran status.
- Highly detail-oriented with advanced organizational and prioritization skills, capable of managing complex and high-priority projects concurrently.
- Expert proficiency in Microsoft Word, Excel, PowerPoint, and Outlook
- Exceptional verbal and written communication skills, including drafting high-level memorandums, letters, and official correspondence.
- Expert knowledge of hospital billing, appeals processes, and denial management, with the ability to handle complex payer disputes, escalated claims and audits.
- In-depth understanding of payer contracts, Medicare/Medicaid guidelines, and audit requirements.
- Strong familiarity with industry best practices in revenue cycle management.
- Proficient in navigating office software, billing systems, and abstracting tools, with demonstrated expertise in using coding resources.
- Advanced understanding of insurance authorizations, benefits, coverage, and eligibility as they relate to medical billing.
- Expertise in reimbursement practices and payer-specific requirements, ensuring compliance and optimal reimbursement.
- Ability to mentor and guide Tier 1 and Tier 2 billers in billing processes and denial resolutions.
- Expertise in conducting root cause analysis and providing solutions to recurring billing issues.
- Stay current on payer-specific guidelines, industry trends, and regulatory requirements to ensure compliance and billing efficiency.
Education: Associates degree is required.
- Review Denied Claims: Analyze denied insurance claims to determine the root cause of denials and identify corrective actions.
- Respond to Payer Audits: Prepare and submit required documentation, including medical records, for payer-requested audits and prepayment reviews.
- Appeal Denials: Develop and submit appeals using medical records, appeal letters, and other supporting documentation to recover denied revenue.
- Trend Analysis: Analyze denial and audit trends to identify patterns and recommend process improvements to reduce future denials.
- Verify Coding Accuracy: Work with corresponding departments to ensure proper ICD-10, CPT, and HCPCS codes are applied in the electronic medical record (EMR) and billing systems.
- Contract Review: Review managed care contracts to verify the appropriate application of reimbursement rates, provisions, and terms.
- Negotiate Resolutions: Communicate with payers to resolve technical denials and ensure compliance with contract provisions and guidelines.
- Track Appeals and Outcomes: Maintain detailed records of appeals, their statuses, and outcomes to ensure timely resolution and accurate reporting.
- Support Process Improvement: Collaborate with clinical denial management and revenue integrity teams to implement strategies that minimize claim denials.
- Educate Staff: Act as a resource for team members on denial reasons, payer-specific policies, and the appeals process, escalating issues when necessary.
- Stakeholder Collaboration: act as a liaison between internal departments and external parties (e.g., payers, auditors) to address claim and audit issues.
- Ensure all work is performed with strict confidentiality while adhering to production and quality goals.
- Handle high-level appeals, including preparing documentation and negotiating outcomes with insurance companies.
- Manage escalated claims with significant financial impact, such as underpayments or disputed claims.
- Conduct root cause analysis on recurring denial issues and recommend solutions.
- Perform all other duties as assigned by supervisor or manager.
- Review Denied Claims: Analyze denied insurance claims to determine the root cause of denials and identify corrective actions.
- Respond to Payer Audits: Prepare and submit required documentation, including medical records, for payer-requested audits and prepayment reviews.
- Appeal Denials: Develop and submit appeals using medical records, appeal letters, and other supporting documentation to recover denied revenue.
- Trend Analysis: Analyze denial and audit trends to identify patterns and recommend process improvements to reduce future denials.
- Verify Coding Accuracy: Work with corresponding departments to ensure proper ICD-10, CPT, and HCPCS codes are applied in the electronic medical record (EMR) and billing systems.
- Contract Review: Review managed care contracts to verify the appropriate application of reimbursement rates, provisions, and terms.
- Negotiate Resolutions: Communicate with payers to resolve technical denials and ensure compliance with contract provisions and guidelines.
- Track Appeals and Outcomes: Maintain detailed records of appeals, their statuses, and outcomes to ensure timely resolution and accurate reporting.
- Support Process Improvement: Collaborate with clinical denial management and revenue integrity teams to implement strategies that minimize claim denials.
- Educate Staff: Act as a resource for team members on denial reasons, payer-specific policies, and the appeals process, escalating issues when necessary.
- Stakeholder Collaboration: act as a liaison between internal departments and external parties (e.g., payers, auditors) to address claim and audit issues.
- Ensure all work is performed with strict confidentiality while adhering to production and quality goals.
- Handle high-level appeals, including preparing documentation and negotiating outcomes with insurance companies.
- Manage escalated claims with significant financial impact, such as underpayments or disputed claims.
- Conduct root cause analysis on recurring denial issues and recommend solutions.
- Perform all other duties as assigned by supervisor or manager.