Insurance Denials Representative

Whitman Hospital and Medical Clinics • Colfax, WA

45d • $23 - $40

About The Position

Rewarding career. Competitive salary. Outstanding benefits. The Insurance Denials Specialist plays a key role within the hospital’s Revenue Cycle team by identifying, analyzing, and resolving denied insurance claims. This position ensures timely and accurate reimbursement for hospital services by managing appeals, correcting billing errors, and partnering with internal departments to reduce future denials.

Requirements

• High school diploma
• At least 3 years of experience with: hospital billing, claims follow-up, or denial management, and Medicare, Medicaid, and commercial insurance payer policies, and UB-04 claims, DRG billing, ICD-10, CPT/HCPCS codes, and payer-specific appeal processes and denial reasons, and Microsoft Office, billing platforms, and electronic health records.
• Ability to work independently and manage time efficiently.

Nice To Haves

• Proficient with EPIC revenue cycle billing system.
• Associate degree in healthcare administration, business, or related field.
• Critical access hospital billing experience
• Certified Revenue Cycle Specialist (CRCS), Certified Professional Coder (CPC), or Certified Coding Specialist (CCS)

Responsibilities

• Denials Resolution and Prevention Review daily denial reports and Explanation of Benefits (EOBs) to identify and prioritize denied or underpaid claims.
• Analyze the root cause of denials, including authorization issues, coding errors, eligibility discrepancies, and coverage limitations.
• Prepare and submit detailed, timely appeals, including necessary clinical documentation and corrected claims.
• Coordinate with clinical teams, medical records, case management, and coding departments to support appeal efforts.
• Communicate with insurance payers to follow up on appeals, secure claim payments, and clarify payer policies as needed.
• Document all follow-up actions and payer communications in the hospital’s billing system accurately and thoroughly.
• Track appeal outcomes, identify denial trends, and report recurring issues to leadership for proactive resolution.
• Ensure compliance with payer-specific rules, HIPAA regulations, and hospital billing policies.
• Meet productivity and accuracy benchmarks as defined by the Revenue Cycle department.
• Monitor payer bulletins, websites, and electronic communications to stay current on policy changes, coding updates, and coverage guidelines.
• Identify potential reimbursement risks or new denial trends resulting from payer policy updates and escalate findings to the Senior Manager of Patient Financial Services.
• Incorporate payer policy changes into denial analysis and collaborate with registration, authorizations, and coding teams to adjust workflows accordingly.
• Review assigned AR aging reports to identify claims at risk of timely filing or prolonged resolution.
• Prioritize follow-up on aged accounts to minimize delays in reimbursement and escalate complex cases to leadership or outsourced billing partners as appropriate.
• Review adjustment requests to ensure they are accurate, properly documented, and compliant with hospital policy and payer requirements prior to processing.
• Verify that insurance remittances are posted correctly in the billing system, including contractual adjustments, patient responsibility, and denial codes.
• Provide cross-coverage within the Patient Financial Services or Patient Access teams as needed.
• Assist with patient billing inquiries related to hospital accounts in a professional and compassionate manner.
• Participate in department meetings, training, and performance improvement initiatives.

Benefits

• Our benefit package includes medical, dental, vision, life insurance, and retirement options (403(b) & 457).
• Medical insurance coverage begins on day one and is available to both full time and part time employees.
• Additionally, employees receive discounts on medical services provided by Whitman Hospital and Medical Clinics.
• Differentials apply for evening, night, and weekend shifts.
• Our unique PTO plan enables employees to increase their accrual with each year of service!

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED