Senior Denials Representative

Denova Collaborative Health•Phoenix, AZ

3d•Hybrid

About The Position

Join Denova Collaborative Health as a Senior Denials Representative, where your expertise in denial management and revenue cycle operations helps recover revenue, reduce preventable denials, and improve financial performance. In this advanced role, you will manage complex appeals, resolve challenging payer issues, develop appeal strategies, and serve as a trusted resource for the denial management team. Your work will directly support Denova's mission of delivering integrated, whole-person healthcare while driving operational excellence and maximizing reimbursement. This position is non-exempt and will report to the RCM System & Solution Mgr.

Requirements

High School Diploma or GED required.
Three or more years of healthcare revenue cycle, denial management, medical billing, or insurance appeals experience with demonstrated accuracy and strong performance.
Experience with Electronic Health Records (EHR) and practice management systems, preferably AMD.
Advanced knowledge of medical billing, insurance appeals, payer regulations, reimbursement methodologies, and denial management.
Strong understanding of CPT, HCPCS, ICD-10 coding, and medical necessity documentation.
Excellent analytical and problem-solving skills with the ability to resolve complex payer issues.
Strong written communication skills with experience preparing professional appeal letters and supporting documentation.
Ability to mentor team members while independently managing complex assignments.
Commitment to maintaining HIPAA compliance and protecting patient information.
Must be located in Arizona.

Nice To Haves

Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
HFMA CRCR certification or other relevant healthcare revenue cycle certification is a plus.

Responsibilities

Manage second-level appeals, payer project submissions, and complex clinical or contractual denials.
Develop comprehensive appeal packages requiring medical records, contract interpretation, and regulatory documentation.
Pursue escalated denials through resolution, including peer-to-peer reviews and external review processes when appropriate.
Ensure all appeals and corrected claims are submitted within payer filing deadlines.
Serve as the primary contact for assigned payer denial projects and monitor progress through resolution.
Coordinate escalations directly with payer representatives and provider relations teams.
Track payer-specific trends and identify opportunities to improve reimbursement outcomes.
Draft and enhance appeal language for new, uncommon, and payer-specific denial scenarios.
Maintain and expand the organization's appeal template library to improve consistency and success rates.
Identify recurring denial patterns and recommend process improvements to reduce future denials.
Serve as a subject matter expert for Denials Representatives by providing guidance on complex appeals, payer requirements, and denial resolution strategies.
Support onboarding and mentor newer team members through informal coaching and knowledge sharing.
Collaborate with leadership and cross-functional departments to improve denial prevention and revenue recovery initiatives.
Meet advanced productivity and quality standards while managing complex denial work.
Participate in and help lead process improvement initiatives.
Perform other related duties as assigned.