The Denials Management Specialist is responsible for analyzing, resolving, preventing, and reporting claim denials and related revenue-cycle issues across Critical Access Hospital, specialty clinic, and Rural Health Clinic settings.
This role manages denial and appeal follow-up, identifies root causes and trends, collaborates with operational, clinical, coding, billing, registration, contracting, and information services teams, and recommends corrective actions to reduce avoidable denials, improve clean-claim performance, support compliant charge capture, and maximize appropriate reimbursement.
The position also supports revenue integrity through analysis of denial patterns, charge-capture and reconciliation processes, unbilled and discharged-not-final-billed accounts, claim edits, payer requirements, and hospital and clinic billing workflows.
Required Qualifications
- High school diploma or equivalent.
- Three years of progressively responsible experience in hospital or physician revenue cycle, patient accounting, medical billing, claims follow-up, denials management, reimbursement, coding, or a related healthcare-finance function.
- Experience working hospital and/or professional claims, payer denials, corrections, reconsiderations, appeals, and timely-filing requirements.
- Working knowledge of Medicare, Medicaid, commercial payer, managed-care, authorization, medical-necessity, coordination-of-benefits, eligibility, coding, and documentation-related denial processes.
- Hands-on experience using Epic for denial management, account research, work-queue management, claim correction, appeal tracking, documentation, and revenue-cycle reporting.
- Intermediate proficiency in Microsoft Excel, including sorting, filtering, formulas, pivot tables, and basic data analysis.
- Proficiency in Word, Outlook, and PowerPoint.
- Ability to analyze data, identify trends and root causes, prioritize workload, meet deadlines, prepare professional written correspondence, and communicate effectively with clinical, operational, financial, and payer stakeholders.
- Ability to work independently while collaborating effectively across departments.
Preferred Qualifications
- Associate or bachelor’s degree in healthcare administration, business, accounting, finance, health information management, or a related field.
- Five or more years of hospital revenue-cycle, revenue-integrity, denials-management, billing, coding, reimbursement, or managed-care experience.
- Advanced experience with Epic Hospital Billing and Professional Billing, including claim edits, work queues, Reporting Workbench, and Slicer Dicer reporting tools.
- Experience managing denials and reimbursement workflows across Critical Access Hospital, Rural Health Clinic, and specialty clinic environments.
- Experience with charge-description-master review, charge capture, charge reconciliation, DNFB management, or hospital revenue integrity.
- Experience interpreting managed-care agreements, payer policies, payment methodologies, and reimbursement terms.
- HFMA certification or relevant revenue-cycle, coding, compliance, or health-information credential.
- Lean, Six Sigma, or other process-improvement training or experience.
Location
Idaho, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
3 weeks ago