Insurance Denials Representative
Whitman Hospital and Medical Center, Colfax, WA, United States
Insurance Denials Specialist
The Insurance Denials Specialist plays a key role within the hospital's Revenue Cycle team by identifying, analyzing, and resolving denied insurance claims. This position ensures timely and accurate reimbursement for hospital services by managing appeals, correcting billing errors, and partnering with internal departments to reduce future denials. Standard Expectations
Promotes a Positive Working Environment Communicates Effectively Performs Duties Efficiently and Effectively Duties & Responsibilities
Denials Resolution and Prevention Review daily denial reports and Explanation of Benefits (EOBs) to identify and prioritize denied or underpaid claims. Analyze the root cause of denials, including authorization issues, coding errors, eligibility discrepancies, and coverage limitations. Prepare and submit detailed, timely appeals, including necessary clinical documentation and corrected claims. Coordinate with clinical teams, medical records, case management, and coding departments to support appeal efforts. Communicate with insurance payers to follow up on appeals, secure claim payments, and clarify payer policies as needed. Document all follow-up actions and payer communications in the hospital's billing system accurately and thoroughly. Track appeal outcomes, identify denial trends, and report recurring issues to leadership for proactive resolution. Ensure compliance with payer-specific rules, HIPAA regulations, and hospital billing policies. Meet productivity and accuracy benchmarks as defined by the Revenue Cycle department. Payer Policy Monitoring Monitor payer bulletins, websites, and electronic communications to stay current on policy changes, coding updates, and coverage guidelines. Identify potential reimbursement risks or new denial trends resulting from payer policy updates and escalate findings to the Senior Manager of Patient Financial Services. Incorporate payer policy changes into denial analysis and collaborate with registration, authorizations, and coding teams to adjust workflows accordingly. Accounts Receivable Aging Review assigned AR aging reports to identify claims at risk of timely filing or prolonged resolution. Prioritize follow-up on aged accounts to minimize delays in reimbursement and escalate complex cases to leadership or outsourced billing partners as appropriate. Revenue Cycle Integrity Review adjustment requests to ensure they are accurate, properly documented, and compliant with hospital policy and payer requirements prior to processing. Verify that insurance remittances are posted correctly in the billing system, including contractual adjustments, patient responsibility, and denial codes. Team Support & Cross-Coverage Provide cross-coverage within the Patient Financial Services or Patient Access teams as needed. Assist with patient billing inquiries related to hospital accounts in a professional and compassionate manner. Participate in department meetings, training, and performance improvement initiatives. Qualifications
Required High school diploma At least 3 years of experience with: hospital billing, claims follow-up, or denial management, Medicare, Medicaid, and commercial insurance payer policies, UB-04 claims, DRG billing, ICD-10, CPT/HCPCS codes, and, payer-specific appeal processes and denial reasons, and, Microsoft Office, billing platforms, and electronic health records. Ability to work independently and manage time efficiently. Preferred Proficient with EPIC revenue cycle billing system. Associate degree in healthcare administration, business, or related field. Critical access hospital billing experience Certified Revenue Cycle Specialist (CRCS), Certified Professional Coder (CPC), or Certified Coding Specialist (CCS) Work Environment and Physical Demands
This position is primarily worked in an office environment. This may include irregular working hours including weekends and on-call responsibilities. Travel to off-site locations for meetings, education and training may be required. Primarily stationary with occasional standing, walking, lifting, reaching carrying, kneeling, bending, stooping, pushing and pulling of objects weighing up to 20lbs. The position requires continuous finger dexterity and fine manipulation. The employee must demonstrate the ability to perform the essential functions of the position, with or without reasonable accommodation. If you are looking for a rewarding career with a great team, you'll enjoy your career with us! Position Details
Hours per week: 40 Employee Status: Regular Full Time Shift: Day Shift (United States of America) Pay Range: $23.00 - $40.25 Compensation: New hires should expect to start at the lower end of the range; actual pay offered will vary based on years of experience. Employee Benefits
Our benefit package includes medical, dental, vision, life insurance, and retirement options (403(b) & 457). Medical insurance coverage begins on day one and is available to both full time and part time employees. Additionally, employees receive discounts on medical services provided by Whitman Hospital and Medical Clinics. Differentials apply for evening, night, and weekend shifts. Our unique PTO plan enables employees to increase their accrual with each year of service!
The Insurance Denials Specialist plays a key role within the hospital's Revenue Cycle team by identifying, analyzing, and resolving denied insurance claims. This position ensures timely and accurate reimbursement for hospital services by managing appeals, correcting billing errors, and partnering with internal departments to reduce future denials. Standard Expectations
Promotes a Positive Working Environment Communicates Effectively Performs Duties Efficiently and Effectively Duties & Responsibilities
Denials Resolution and Prevention Review daily denial reports and Explanation of Benefits (EOBs) to identify and prioritize denied or underpaid claims. Analyze the root cause of denials, including authorization issues, coding errors, eligibility discrepancies, and coverage limitations. Prepare and submit detailed, timely appeals, including necessary clinical documentation and corrected claims. Coordinate with clinical teams, medical records, case management, and coding departments to support appeal efforts. Communicate with insurance payers to follow up on appeals, secure claim payments, and clarify payer policies as needed. Document all follow-up actions and payer communications in the hospital's billing system accurately and thoroughly. Track appeal outcomes, identify denial trends, and report recurring issues to leadership for proactive resolution. Ensure compliance with payer-specific rules, HIPAA regulations, and hospital billing policies. Meet productivity and accuracy benchmarks as defined by the Revenue Cycle department. Payer Policy Monitoring Monitor payer bulletins, websites, and electronic communications to stay current on policy changes, coding updates, and coverage guidelines. Identify potential reimbursement risks or new denial trends resulting from payer policy updates and escalate findings to the Senior Manager of Patient Financial Services. Incorporate payer policy changes into denial analysis and collaborate with registration, authorizations, and coding teams to adjust workflows accordingly. Accounts Receivable Aging Review assigned AR aging reports to identify claims at risk of timely filing or prolonged resolution. Prioritize follow-up on aged accounts to minimize delays in reimbursement and escalate complex cases to leadership or outsourced billing partners as appropriate. Revenue Cycle Integrity Review adjustment requests to ensure they are accurate, properly documented, and compliant with hospital policy and payer requirements prior to processing. Verify that insurance remittances are posted correctly in the billing system, including contractual adjustments, patient responsibility, and denial codes. Team Support & Cross-Coverage Provide cross-coverage within the Patient Financial Services or Patient Access teams as needed. Assist with patient billing inquiries related to hospital accounts in a professional and compassionate manner. Participate in department meetings, training, and performance improvement initiatives. Qualifications
Required High school diploma At least 3 years of experience with: hospital billing, claims follow-up, or denial management, Medicare, Medicaid, and commercial insurance payer policies, UB-04 claims, DRG billing, ICD-10, CPT/HCPCS codes, and, payer-specific appeal processes and denial reasons, and, Microsoft Office, billing platforms, and electronic health records. Ability to work independently and manage time efficiently. Preferred Proficient with EPIC revenue cycle billing system. Associate degree in healthcare administration, business, or related field. Critical access hospital billing experience Certified Revenue Cycle Specialist (CRCS), Certified Professional Coder (CPC), or Certified Coding Specialist (CCS) Work Environment and Physical Demands
This position is primarily worked in an office environment. This may include irregular working hours including weekends and on-call responsibilities. Travel to off-site locations for meetings, education and training may be required. Primarily stationary with occasional standing, walking, lifting, reaching carrying, kneeling, bending, stooping, pushing and pulling of objects weighing up to 20lbs. The position requires continuous finger dexterity and fine manipulation. The employee must demonstrate the ability to perform the essential functions of the position, with or without reasonable accommodation. If you are looking for a rewarding career with a great team, you'll enjoy your career with us! Position Details
Hours per week: 40 Employee Status: Regular Full Time Shift: Day Shift (United States of America) Pay Range: $23.00 - $40.25 Compensation: New hires should expect to start at the lower end of the range; actual pay offered will vary based on years of experience. Employee Benefits
Our benefit package includes medical, dental, vision, life insurance, and retirement options (403(b) & 457). Medical insurance coverage begins on day one and is available to both full time and part time employees. Additionally, employees receive discounts on medical services provided by Whitman Hospital and Medical Clinics. Differentials apply for evening, night, and weekend shifts. Our unique PTO plan enables employees to increase their accrual with each year of service!