Managed Care Analyst - Denials & Underpayment Recovery

Department Patient Financial Services Job SummaryThe Sarasota Memorial Patient Financial Services Team is Hiring Now! Apply Today! Responsible for pursuing reimbursement on denied and underpaid hospital claims from commercial and managed care payers. This role performs detailed account review, prepares and submits written appeals, conducts payer follow-up calls, and works underpayment and denial accounts through resolution to maximize contractual reimbursement. Maintains documentation of appeal activity and payer responses, tracks recovery outcomes, and collaborates with internal teams to resolve claim issues. Requires working knowledge of managed care reimbursement, denial reason codes, payer appeal processes, and contract reimbursement methodologies. Onsite position. Monday through FridayFlexible start timeRequired QualificationsMinimum five (5) years of healthcare collections, denial management, appeals, or payer follow-up experience in a hospital or health system setting (Bachelor's degree may substitute for required experience) Demonstrated experience submitting payer appeals and working insurance denials Experience reviewing EOBs/ERAs and identifying underpayments Knowledge of commercial and managed care reimbursement processes Experience performing outbound payer follow-up calls Strong written documentation and account note skills Ability to manage a high-volume workload and meet productivity expectations Preferred QualificationsCRCR or CRCS certification Experience with hospital billing systems and AR work queues Experience with managed care contracts and reimbursement terms Familiarity with contract modeling and reimbursement analysis tools (e.g., PMMC or similar platforms) Working knowledge of CPT, HCPCS, DRG, and ICD-10 coding concepts Strong spreadsheet and tracking skills Ability to interpret and analyze denial rationale and determine appropriate appeal action with insurance payers Ability to analyze denial reasons and payment variances Strong written appeal letter skills Ability to manage high-volume account follow-up and payer correspondence Mandatory Education HS EQ: High School Diploma, GED or Certificate Preferred Education AD: Associate's Degree Preferred License and CertsCertifications (Preferred) Certified Revenue Cycle Representative (CRCR) Certified Revenue Cycle Specialist (CRCS) Sarasota Memorial Hospital was recently recognized again by ranking #1 Hospital in the Region by the U.S. News's Best Hospital report by scoring a Perfect 10! Not only that, but SMH was also designated at a national "standout" hospital for earning top ratings in all evaluated conditions and procedures - an accomplishment achieved by less than 1% of the 4000+ hospitals. Our system has also earned Magnet® recognition from the American Nurses Credentialing Center (ANCC), as well as these additional accolades: Gallup Great Workplace 2018; recipient of an "A" grade for Patient Safety. Sarasota Memorial Hospital is Magnet designated and the only provider of Level II trauma services, obstetrical services, and Level III neonatal intensive care in Sarasota County. Reputation. Community. Impact. Growth. Every day, our patients at Sarasota Memorial Health Care System receive a first-class experience in care from a team on a mission to deliver the highest level of care in America. In the process of rising to that challenge, one by one, our people are finding their purpose and feeling their impact. Now it is your turn to see yourself here. Recognition: 5- Star Quality Rating- SMH- Sarasota is the only hospital in Florida to earn the federal Centers for Medicare & Medicaid Services' highest rating every year since its inception. 50 Best Hospitals- SMH ranked among U.S. News & World Report's 50 Best Hospitals in two specialties, Rehabilitation and Obstetrics/Gynecology in 2023-2024, and among the nation's top 10% high performers in 18 other medical specialties, procedures and conditions. World's Best Hospitals- SMH- Sarasota has made Newsweek's prestigious list six years in a row, since the global rankings began in 2019. "A" for Patient Safety- SMH- Sarasota has earned straight A's since it began participating in the Leapfrog Group's hospital safety survey in 2016. Magnet Hospital- SMH has been recognized as a Magnet hospital for the past 20 years by the American Nurses Credentialing Center, a continuous achievement for nursing excellence shared by less than 1% of hospitals nationwide. America's Best Employer/Workplace- SMH topped Forbe's list of America's Best Employers, ranking among the top 20% of large employers across all industries in 2024, and #1 healthcare employer in Florida in 2023. The health system also earned a 5-star rating in Newsweek's 2024 list of "America's Greatest Workplaces for Women." The benefits of being the best: Our commitment to becoming the best community hospital and health care system means providing the best possible benefits to our people. Some highlights: Total Rewards Package Paid Time Off (start earning PTO on day one of employment) Tuition Reimbursement Discounted Medical, Prescription, Dental, Vision Benefit Plans for Full & Part-Time Employees Flexible Spending Accounts (Health Care and Dependent Care) - Pre-Tax Dollars Life Insurance Competitive rates Bonuses offered Disability Insurance Retirement Savings Plan: 403b Sarasota Campus for now - Discounted Child Care & Before and After School Program and Summer Camp! Bereavement Leave Free Parking On Campus Dining w/ a 10% discount Credit Union w/ teller machines on campus Direct Deposit Free Wellness Screening Free confidential counseling services Employee Discount Programs Recognition Programs Referral Programs Tremendous growth opportunities for hard workers! Employment Screening Requirements As part of Sarasota Memorial Health Care System's commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse.

Created: 2026-03-04