Denials Representative

860909, No, 5770, 2337, 1, 0.0, 0.0, 31-Aug-2026, Denials Representative, Full-Time, Denials Representative, Remote, Louisville, TN,

QUALIFICATIONS / EXPERIENCE:

• High school diploma or equivalent.
• Minimum two years previous medical billing experience required with emphasis on research and claim denials in Accounts Receivable preferred.
• Demonstrated knowledge of physician billing.
• Demonstrated knowledge of health care reimbursement guidelines.
• Knowledge of ICD-10 and CPT-4 coding.
• Excellent oral and written communication.
• Knowledge of denials and review policies for all plans.
• Thorough working knowledge of physician billing policies and procedures.
• Computer literate.
• Excellent follow-up skills.
• Excellent organizational skills.
• Training classes and seminar attendance may require travel.

SUPERVISORY RESPONSIBILITIES:

• None

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• JOB DESCRIPTION OVERVIEW:

Position is responsible for reviewing rejections assigned to Denials Resolution in ETM System. Maintains accuracy and production to ensure denials are being processed efficiently.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Reviews ETM worklist to process rejections according to written procedures.
• Reviews rejections to identify trends and carrier issues that need to be reported to management.
• Obtains appropriate carrier information for rejected claims.
• Information obtained from carrier indicates related to provider rejection. Directs rejections to the Provider Enrollment Department.
• Maintain knowledge of ETM system.
• Participates in monthly meeting with Denials Resolution Supervisor.
• Communicates with Denials Resolution Supervisor for unusual circumstances that may include adjustments, denials, fee schedules, claims, etc.
• Performs any and all duties as directed by Senior Representative, Denials Resolution Supervisor and Accounts Receivable Manager.