Denial Management Representative - Remote

1. About Our Client:This organization operates within the healthcare revenue cycle management space, focusing on the resolution of patient accounts from creation through payment. It addresses challenges related to insurance claims processing, collections, and account disputes involving both government and non-government payors. The organization emphasizes maintaining an efficient revenue cycle by managing insurance collections, patient billing, and compliance with relevant regulations.2. About the Opportunity:The **Denial Management Representative** is responsible for ensuring timely resolution of patient accounts by following up on claim submissions, reviewing remittances, and pursuing disputed balances. This role supports the revenue cycle by identifying and resolving insurance payment issues, working independently and collaboratively to clear accounts and improve cash flow. The position contributes to the organization’s financial health by minimizing delays and rework in account collections.3. Responsibilities:• Research patient accounts using internal applications and internet resources• Contact third-party payors and patients via phone, email, or online to resolve uncollected balances• Update plan IDs, adjust patient or payor information, and document account details clearly• Identify payor issues and trends, resolve recoupment issues, and request additional documentation as needed• Review contracts for billing or coding issues and request corrected bills or secondary billing• Take timely actions to resolve accounts or open dispute records for further collection efforts• Maintain workload inventory to meet productivity and quality standards• Assist with special projects, documenting findings and communicating results• Monitor payor delays and trends, escalating aged accounts to supervisors as necessary• Participate in meetings, training, and in-services to improve job knowledge• Respond promptly to emails and phone messages• Ensure compliance with State and Federal laws for managed care and third-party payors4. Requirements:• Thorough understanding of the revenue cycle from patient access to collections• Intermediate proficiency in Microsoft Word and Excel• Ability to quickly learn hospital systems such as ACE, VI Web, IMaCS, and OnDemand• Clear and professional communication skills, both oral and written• Strong interpersonal, analytical, and critical thinking abilities• Knowledge of Commercial, Managed Care, Medicare, and Medicaid collections• Familiarity with managed care contracts, contract language, and government payor requirements• Understanding of HMO, PPO, IPA, Capitation, EOBs, UB04, and HCFA 1500 forms• Ability to problem solve, prioritize tasks, and follow through completely• High School diploma or equivalent; some college coursework in business administration or accounting preferred• 1 to 4 years of medical claims or hospital collections experience• Minimum typing speed of 45 words per minute5. Pay Range and Compensation Package:• The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.Equal Opportunity Statement:Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.Note:RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.