Denial Management Associate

EvergreenHealth•Kirkland, WA

13d•$26 - $42

About The Position

Responsible for the initial screening, routing, and prevention of payer denials. This role supports core payer denial resolution processes. Serves as the primary contact for denied claims, determining whether items are appealable, require rebilling or correction, or should be routed to operational teams for resolution. The coordinator identifies authorization-related denial trends and partners with clinical and operational departments to reduce future denials. This position is accountable for reducing preventable denials and downstream appeal volume, enabling staff to focus on high-value appeals.

Requirements

Associate’s degree in related area or equivalent combination of education and experience
2 years of experience in denial management, utilization review, or prior authorization in a hospital, provider, or healthcare system.
Experience supporting denial prevention or root cause analysis initiatives.
Knowledge of authorization processes.
Strong written and verbal communication skills for cross-department collaboration.
Demonstrated attention to detail.

Nice To Haves

Experience with Epic electronic medical record (EMR) system
Ability to work independently and productively in a remote work environment.
General knowledge of healthcare revenue cycle including familiarity with reimbursement methodology, charge capture, and billing processes.

Responsibilities

Reviews incoming payer denials to determine appropriate disposition using standardized triage criteria.
Routes denials to the appropriate work queues, teams, or departments for appeal, rebilling, or operational resolution.
Identifies denials requiring charge correction, coding updates, or claim rebilling and coordinates timely handoff to Billing, Coding, or Follow-up.
Monitors rebill-related denials to confirm corrective action and claim resubmission occurs within established timeframes.
Analyzes denials to identify preventable denials by department, service line, or payer and communicates trends to operational leaders.
Supports denial prevention efforts through education, workflow clarification, and documentation standardization.
Supports reporting and leadership review by tracking and documenting triage effectiveness, including routing decisions and denial trends.
Assists with appeal preparation activities for defined categories, projects, or trends, including drafting appeal letters and assembling supporting documentation, in collaboration with the Denial Management Specialist.
In conjunction with Denial Management Specialist, assists with follow-up on submitted appeals, documentation tracking, and other appeal-related support activities.
Performs other duties as assigned.