Epic Denials Management Operator

Join Deloitte's AI & Engineering practice to support hospital denials management and deliver back-end Revenue Cycle Management (RCM) services, including billing and claims submission, A/R follow-up, denials management, payment posting, and credits and refunds, for a health care provider client.

This is a primarily remote role supporting enterprise Epic support, with minimal travel and scheduled onsite time as needed.

What you'll do

Support review of denials (835/277 processing) received from third-party payers.

Conduct denial categorization and root cause analysis based on remittance information received from payers. Review hospital account records and payer remittance records, communicate with Client RCM and internal hospital stakeholders, and contact payers through portals and phone calls to gather information needed to understand denial reasons and root causes. Determine appropriate denial responses, develop denial appeal letters using templates, and submit appeals to third-party payers. Rebill corrected claims and route issues to coding, billing, credentialing, denials, and/or clinical teams as needed.

Provide additional documentation to payers to resolve denial issues. Document denial details, research, and follow-up activities in EMR and patient accounting systems. Review AR aging reports and work queues to identify unpaid and delayed claims. Follow up on open denials, appeals, and other outstanding balances to understand claim status and payer requirements.

Work within Epic Resolute Hospital Billing, claims clearinghouse systems, payer websites and portals, and other workflow tools while adhering to SOPs and productivity and quality standards.