Denials Representative

Job Description

REQUIREMENTS

• High school diploma or equivalent
• 1+ years of physician medical billing experience with a focus on claims research and denial resolution
• Knowledge of physician billing practices, reimbursement processes, and healthcare payer guidelines
• Working knowledge of Microsoft Excel and other business applications
• Understanding of ICD and CPT coding principles
• Ability to consistently meet quality, productivity, and attendance expectations

RESPONSIBILITES

• Review, prioritize, and resolve assigned payment denials within established timelines
• Research claim issues using payer websites, phone outreach, and available resources
• Prepare and submit appeals and supporting documentation through appropriate channels, including Waystar when applicable
• Follow up with insurance carriers regarding denied and appealed claims
• Escalate provider-related issues with appropriate documentation for further review
• Monitor payer updates and communicate changes that may impact claims processing
• Identify recurring claim errors and recommend opportunities for improvement
• Support the development and refinement of denial management procedures
• Consistently meet quality, productivity, and turnaround expectations

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