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Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital role, you will focus on the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied claims, and collaborating across departments including with physicians, providers, and administrative teams to create effective, patient-centered solutions.

At UHS, every connection matters, and your ability to connect clinical knowledge with financial insight directly impacts our patients and our organization. You will play a key role in tracking denial trends, educating clinical staff to prevent future issues, and ensuring that care delivered is care reimbursed. Join us in building a stronger healthcare system, one connection at a time.

Primary Department, Division, or Unit:

UHS Managed Care Contracting

Primary Work Shift:

Day

Regular Scheduled Weekly Hours:

40

Compensation Range:

$37.00 - $55.50 per hour, depending on experience

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Job Responsibilities:

+ Prepare and submit timely, well-documented appeals for denied services to Medicare, Medicaid, and commercial payers, including Insurance Reviewers, Hearing Officers, and Administrative Law Judges.

+ Track and evaluate denial patterns to identify root causes and collaborate with internal teams to implement strategies that reduce future denials.

+ Work with providers and hospital departments to ensure services are billed under the correct admission status and that documentation supports billing requirements.

+ Partner with physician and hospital coders to ensure accurate CPT coding for emergency Medicare admissions and support correct hospitalization status determinations.

+ Collaborate with insurance verification staff to resolve authorization issues and address denials related to coverage and precertification.

+ Conduct real-time reviews of medical and surgical administrative denials and provide clinical recommendations to assist in resolution.

+ Work closely with concurrent case managers to understand payer-specific contract requirements and develop preventative workflows for denials.

+ Support the pre-certification and payer authorization process to ensure accurate and timely approvals that safeguard payment for services rendered.

+ Collaborate with third-party payers to anticipate issues that could lead to denial of payment and act early to resolve those issues.

+ Serve as a resource and mentor for clinical and administrative staff across departments, answering questions and guiding staff through system-wide denial management processes.

+ Attend monthly meetings with provider representatives from major insurance payers such as Aetna, Excellus, UHS, and WellCare to stay informed and advocate for resolution of systemic issues.

+ Work with physician offices, the Insurance Verification team, EHR analysts, and Care Managers to address administrative and medical necessity denials and keep teams updated on payer policies and process changes.

Position Qualifications:

Minimum Required:

+ Associate in applied science in Nursing with a minimum of five (5) years of experience in acute/tertiary facility.

+ Minimum Required: NYS Licensed Registered Nurse

Preferred:

+ Bachelor's of Science in Nursing with three (3) years of experience in acute / tertiary facility, denial management and/or revenue cycle experience.

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Why You’ll Love Working at UHS

At United Health Services (UHS), we believe every connection—to patients, to purpose, to each other—makes a difference. That’s why we’re intentional about supporting our team in ways that go beyond the job. Whether through meaningful benefits, personal growth, or fun along the way, we’re here to help you thrive in work and life.

A Culture of Connection – We support each other like family and create space for every voice to be heard. Engagement Councils, peer recognition, and initiatives like Walk in my Shoes for senior leaders are just a few ways we foster belonging and collaboration. Outside of work, we stay connected through team events like trivia, trunk-or-treat, volunteer days, our staff choir, or seasonal celebrations.

Comprehensive Benefits for Life & Family – We offer medical, dental, and vision coverage starting the first of the month after hire for employees working 24+ hours/week. With flexible plan options and coverage tiers, you can choose what fits your life best. Additional perks include discounted childcare through Bright Horizons and voluntary benefits like pet insurance, legal services, and identity theft protection.

•Well-Being & Financial Security – From day one, PTO starts accruing so you can take time to recharge. We support your long-term wellness with a 403(b) retirement plan and company match, flexible spending accounts, access to financial advisors, and up to $400/year in wellness rewards. When life gets tough, we’re here with 24/7 EAP counseling, virtual mental health support, a food pantry, PTO donation program, and professional attire through the Classy Closet.

•Growth That Moves with You – With access to 100,000+ online courses, leadership programs, tuition reimbursement, clinical ladders, and internal mobility, we help you grow wherever your passion leads. We also continuously review compensation to ensure market competitiveness and internal equity, so you can feel confident your work is valued and rewarded fairly.

•A Place to Call Home – Located in New York’s Southern Tier, UHS offers more than a career—we offer a lifestyle. Enjoy four-season recreation, affordable living, top-rated schools, minor league sports, craft brews, a close-knit community, and more, all within reach of the Finger Lakes, the Catskills, and major Northeast cities.

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About United Health Services

United Health Services (UHS) is a locally owned, not-for-profit healthcare system in New York’s Southern Tier comprising four hospitals, long-term care and home care services, and physician practices in Broome and surrounding counties. UHS provides healthcare and medical services for two-thirds of the region’s population, produces $1.3 billion a year in total economic impact, and boasts a workforce of more than 6,300 employees and providers.

At UHS, our work is guided by our Values of Compassion, Trust, Respect, Teamwork, and Innovation. Whether you provide direct patient care or support behind the scenes, you are part of a shared purpose: to improve the health and well-being of the communities we serve. Every employee plays a meaningful role in fulfilling our mission—we’d love for you to consider joining us!

United Health Services is an Equal Opportunity Employer.

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United Health Services, Inc. and the members of the UHS System neither are affiliated with, sponsored, endorsed nor approved by, nor otherwise associated with, Universal Health Services, Inc. (NYSE: UHS), UHS of Delaware, Inc. nor their affiliates, which can be found at www.uhsinc.com.