Revenue Cycle Denial Specialist (FT- 1.0 FTE, Day Shift, Remote)

Bozeman Health

7d•Remote

About The Position

The Revenue Cycle Denial Specialist reviews, analyzes, and resolves post-billed denials and rejections for hospital and professional claims to support accurate reimbursement and denial prevention. This role applies expertise in payer requirements, government regulations, and appeal processes to determine root cause, validate denial rationale, and drive corrective actions. The specialist prepares and manages appeals within required timelines, collaborates across departments to reduce avoidable denials, and provides reporting and education to support system-wide revenue cycle performance. Provides reporting, analysis, and coordination support for the Denial Steering Committee and Task Force to drive denial reduction strategies and operational improvements.

Requirements

Associate's degree or Certification in Healthcare Business, or related field, or equivalent combination of education and experience may be considered.
Three (3) years of healthcare experience in a revenue cycle position.
Three (3) years of experience working with International Classification of Diseases, Tenth Revision (ICD-10) diagnosis and procedure coding, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), modifiers, and coding guidelines.
Proficiency with Microsoft Office applications, including advanced Excel, Word, and PowerPoint skills.

Nice To Haves

Healthcare Financial Management Association Revendure Cycle Representative (HFMA CRCR) or Certified Professional Coder (CPC) certifications.
Five (5) years of experience in a hospital revenue cycle billing position.
Experience with Epic or other electronic medical record (EMR) applications.
Experience using payer portals, electronic work queues, and denial/appeals tracking tools.

Responsibilities

Analyze denials to determine root cause, appeal eligibility, and appropriate resolution strategy.
Prepare, submit, and track payer appeals and reconsiderations within required timeframes.
Manage the full appeal lifecycle, ensuring compliance with contractual and regulatory requirements.
Monitor denial and appeal trends; develop reports and dashboards for leadership and committees.
Present findings and recommendations to support denial reduction and process improvement efforts.
Collaborate with coding, billing, clinical, compliance, and operational teams to address denial drivers.
Develop and deliver education and training to reduce avoidable denials and improve workflows.
Support denial-related committees and task forces through reporting, analysis, and coordination.
Manage audit requests, including Recovery Audit Contractor (RAC) and governmental audits, ensuring timely submission and tracking.
Perform audits and utilize reporting tools (e.g., Epic) to support data analysis and operational insights.
Maintain knowledge of payer rules, state and federal regulations, and reimbursement requirements.