Denials Follow Up Representative

About the Company

The organization helps healthcare clients strengthen their financial performance by supporting reimbursement-cycle needs with scalable services and clinical expertise. Its approach combines analytics and technology to improve outcomes and keep teams focused on measurable goals.

The company emphasizes long-term careers and invests in employee growth, aiming to create a workplace that supports both professional development and personal advancement.

Role Summary

This position sits within a healthcare revenue-cycle environment and supports providers with denial management and follow-up work. The team serves more than 300 providers across 25+ states and offers a client-focused model designed to adapt services, consulting, and technology as client needs change.

The business operates across areas such as denials management, complex claim resolution, accounts receivable outsourcing, patient access, revenue cycle technology, and consulting.

Key Duties

• Review denial cases and distinguish clinical denials from technical denials using explanation of benefits, payer letters, correspondence, and data review.
• Examine UB-04 and/or HCFA 1500 claim forms as part of denial analysis.
• Check timely-filing rules and appeal deadlines before moving forward with follow-up action.
• Work with payers to resolve technical denials and negotiate appropriate outcomes.
• Submit appeals using available support materials such as appeal letters, medical records, and clinician input when needed.
• Assess appeal results and determine the next step, including fund recovery entry, acceptance of an upheld decision, or initiation of a second-level appeal.
• Track assigned accounts, maintain accurate documentation, and ensure timely follow-up on all work.

Qualifications and Core Competencies

A four-year degree is preferred, though comparable experience in hospital billing or follow-up may be considered instead. Candidates should also have experience with managed care contracts and customer support or client issue resolution work.

Strong analytical thinking, the ability to handle multiple priorities, and solid proficiency with Microsoft Office are important for success in this role.

Physical Requirements

The role requires regular eye-hand coordination and manual dexterity for office equipment use, along with the ability to work at a computer for 6 to 8 hours per day. The work environment includes frequent interruptions and occasional extended sitting. At times, the role may require lifting and moving items weighing up to 20 lbs. Periods of heavier workload may also involve increased stress and multiple deadlines.

Additional Notes

Reasonable accommodations may be provided to help individuals with disabilities perform the essential functions of the role. The duties listed are meant as a general guide rather than a complete inventory, and supervisors may assign additional responsibilities or requirements as needed.