Denials Management Specialist

Grand River Health Main Campus•Rifle, CO

11d•$29 - $42•Onsite

About The Position

The Denials Management Specialist is responsible for identifying, investigating, appealing, and resolving denied or underpaid insurance claims to maximize reimbursement and minimize revenue loss. This role works closely with billing, coding, patient financial services, and clinical departments to ensure timely resolution of claim denials, identify root causes, and support process improvements that enhance revenue cycle performance.

Requirements

High school diploma or equivalent required
Two (2) years of experience in healthcare revenue cycle operations, medical billing, accounts receivable, denial management, or a related healthcare financial role preferred.
Working knowledge of healthcare revenue cycle processes, insurance claim adjudication, reimbursement methodologies, and payer regulations, including Medicare, Medicaid, commercial insurance, and managed care requirements.
Understanding of CPT, ICD-10-CM, and HCPCS coding principles and their impact on reimbursement and claim resolution.
Proficiency with electronic health records (EHRs), patient accounting and revenue cycle systems, Microsoft Office applications, and the ability to become proficient in organizational software systems within six (6) months of hire.
Strong analytical, organizational, and problem-solving abilities with the capacity to interpret payer guidelines, analyze financial information, and determine appropriate courses of action.
Excellent verbal and written communication skills, attention to detail, sound judgment, and the ability to work independently and collaboratively while managing multiple priorities and deadlines.

Nice To Haves

Associate degree in Healthcare Administration, Business Administration, Health Information Management, or a related field preferred.

Responsibilities

Review, prioritize, and investigate denied, rejected, and underpaid claims from government and commercial payers to determine appropriate resolution strategies.
Prepare, submit, and monitor appeals while following payer guidelines, regulatory requirements, and organizational policies.
Collaborate with billing, coding, registration, authorization, patient financial services, and clinical teams to obtain documentation and resolve claim issues.
Communicate with insurance carriers regarding claim status, payment discrepancies, appeal outcomes, and reimbursement concerns.
Analyze denial trends, generate reports, and identify root causes impacting reimbursement and revenue cycle performance.
Recommend and support process improvements, staff education, and denial prevention initiatives to improve clean claim rates and financial outcomes.
Maintain accurate documentation of denial activity while meeting established productivity, quality, and departmental standards, and participate in ongoing training and improvement efforts.