DenialsFollowUpRep

## Accountabilities Review and analyze insurance denials using EOBs, payer correspondence, and claims data to determine appropriate resolution strategies. Differentiate between clinical and technical denials and identify required next steps for appeals or reprocessing. Prepare and submit appeals using supporting documentation such as medical records, appeal letters, and clinical justification when necessary. Contact insurance payers directly to negotiate resolution of denied claims and ensure timely follow-up on accounts. Evaluate appeal outcomes to determine whether payments were recovered, decisions upheld, or additional appeal levels are required. Manage assigned accounts with accurate documentation, tracking, and timely updates within billing and follow-up systems. Apply knowledge of billing forms (UB-04 and HCFA 1500), DRG downgrades, and managed care contracts to support effective resolution. Requirements: High school diploma required; bachelor’s degree preferred or equivalent experience in hospital billing or revenue cycle operations. At least 2 years of experience in healthcare billing, claims follow-up, or denial management. Strong understanding of insurance claim processes, including clinical and technical denial classification. Familiarity with UB-04 and HCFA 1500 forms and DRG downgrade processes. Experience working with managed care contracts and payer communication. Strong analytical skills with the ability to interpret complex billing and reimbursement data. Excellent multitasking, organization, and time management abilities in a high-volume environment. Proficiency in Microsoft Office and general billing or claims management systems. Benefits: Comprehensive medical, dental, and vision insurance coverage. 401(k) retirement savings plan. 80 hours of annual paid time off plus 9 paid holidays. Tuition reimbursement and professional development support. Fully remote work setup with provided equipment. Career growth opportunities within healthcare revenue