Denials Management Follow Up Representative

Job description

**This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Denials Management Follow Up Representative based in the United States.** The Denials Management Follow Up Representative plays a key role in optimizing healthcare revenue cycle operations by ensuring timely resolution of insurance denials and appeals. In this fully remote, full-time position, you will coordinate follow-up activities with third-party payors to secure appropriate reimbursement for institutional and professional claims. You will monitor appeal statuses, investigate payment issues, maintain accurate tracking systems, and analyze performance data to identify trends and opportunities for improvement. Working closely with revenue integrity teams and other healthcare stakeholders, you will help streamline processes, strengthen billing accuracy, and support effective revenue recovery. Your expertise in hospital patient accounting, insurance payment rules, and claims management will contribute to efficient financial operations. This opportunity is ideal for a detail-oriented healthcare revenue cycle professional who combines analytical thinking, strong communication skills, and a commitment to high-quality work. ### Accountabilities - **Denials & Appeals Follow-Up:** Coordinate denial and appeal follow-up activities to ensure third-party payors respond promptly and process outstanding institutional and professional claims, documentation requests, and appeals appropriately. - **Insurance Payor Communication:** Contact insurance carriers to investigate outstanding appeals, clarify payment decisions, resolve reimbursement issues, and facilitate the collection of amounts owed following successful appeals. - **Workflow Coordination:** Monitor daily denial management and appeal follow-up activities, collaborate with relevant stakeholders, and ensure outstanding items receive timely attention. - **Tracking System Administration:** Maintain the denial management tracking application, including activity records, user access, software updates, and end-user training to support consistent follow-up processes. - **Reporting & Performance Analysis:** Collect, organize, and analyze information from multiple systems to produce regular status reports, performance metrics, and trend analyses for designated stakeholder groups. - **Documentation & Record Management:** Maintain complete, accurate, and easily retrievable records of denial activity, appeal submissions, payor responses, and follow-up actions to support efficient case management. - **Committee & Review Support:** Coordinate denial-related review activities and prepare supporting documentation, analytical reports, and other materials for committee meetings. - **Revenue Integrity Projects:** Support departmental initiatives by coordinating meetings, researching insurance payor criteria, preparing documentation, and contributing to process improvement activities. - **Compliance & Payment Accuracy:** Apply knowledge of insurance billing requirements, reimbursement methodologies, coding standards, and government and managed care payment policies to support accurate claims resolution. - **Cross-Functional Collaboration:** Communicate clearly with internal teams and external payors, helping resolve issues, share relevant information, and maintain high standards of service and work quality. ## Requirements - **Professional Experience:** 5–7 years of experience in a healthcare patient accounting or revenue cycle environment, with practical knowledge of hospital billing, denials, appeals, and reimbursement processes. - **Education:** Bachelor's degree or an equivalent combination of education and relevant professional experience. - **Revenue Cycle Expertise:** Strong understanding of hospital revenue cycle management, including electronic data interchange (EDI) transaction sets such as 837I and 837P, insurance contract rates, reimbursement terms, registration, and collections. - **Claims & Payment Knowledge:** Understanding of government and managed care billing requirements, insurance coverage policies, payment rules, and reimbursement procedures. - **Remittance Interpretation:** Ability to interpret electronic and paper Explanation of Benefits (EOB) documents and payor 835 remittance advice responses to investigate claim outcomes and identify payment discrepancies. - **Medical Coding & Billing:** Familiarity with Correct Coding Initiative (CCI) edits, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), ICD-10 diagnosis codes, and revenue codes. - **Healthcare Technology:** Experience using Epic electronic medical record systems, particularly Hospital Billing (HB) and/or Professional Billing (PB) modules. - **Data Management & Reporting:** Ability to maintain accurate tracking records, consolidate information from multiple systems, analyze performance metrics, and prepare clear, actionable reports. - **Organization & Attention to Detail:** Strong organizational skills and the ability to manage multiple cases, documentation requirements, deadlines, and follow-up priorities while maintaining accurate records. - **Communication & Collaboration:** Excellent written and verbal communication skills, with the ability to coordinate effectively with insurance representatives, internal departments, and cross-functional stakeholders. - **Problem-Solving & Accountability:** Strong analytical skills, initiative, and a commitment to resolving payment issues, improving workflows, and delivering consistently high-quality work. - **Preferred Experience:** At least 3 years of experience in hospital third-party collections or accounts receivable management is preferred. - **Remote Work Readiness:** Ability to work independently, manage priorities, and collaborate effectively in a fully remote environment. ## Benefits - **Remote Work:** Fully remote position based in the United States. - **Full-Time Employment:** Stable, full-time opportunity within a healthcare organization focused on patient care, research, and operational excellence. - **Comprehensive Healthcare Coverage:** Eligible employees receive medical, dental, and vision insurance. - **Retirement Benefits:** Retirement savings plan with employer matching, subject to applicable plan terms. - **Tuition Assistance:** Educational support to encourage professional development and continued learning. - **Meaningful Work:** Contribute to the financial operations supporting specialized pediatric healthcare and services for children and their families. - **Professional Development:** Opportunity to deepen expertise in hospital revenue cycle management, denial resolution, insurance reimbursement, and revenue integrity. - **Collaborative Environment:** Work with healthcare professionals and operational teams committed to quality, accountability, innovation, and continuous improvement. - **Experience-Based Compensation:** Compensation is determined according to relevant professional experience and internal departmental equity. A specific salary range was not provided in the available job description.