Denials Follow Up Representative

Job Summary

To support healthcare providers in managing revenue cycle challenges, the full-time Denials Follow Up Representative will work remotely to differentiate between clinical and technical denials, negotiate resolutions with payers, and manage appeals processes while maintaining accurate records.

Key responsibilities:

• Differentiates between clinical and technical denials through EOBs, denial letters, and data mining
• Contacts payers to negotiate resolutions on technical denials and manages follow-up on assigned accounts
• Appeals denials using various means, including appeal letters and medical records, while evaluating outcomes for next steps

Required qualifications:

• High School Diploma; four-year degree preferred or equivalent experience in hospital billing/follow-up
• At least 2 years of experience in the hospital-related billing/follow-up field
• Knowledge of UB04 and/or HCFA 1500 forms and understanding of DRG downgrades
• Experience with managed care contracts and customer support/client issue resolution management
• Proficiency with MS Office and strong analytical skills