Denials Follow Up Rep in United States at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Denials Follow Up Rep based in the United States.

This role focuses on supporting healthcare revenue cycle operations by identifying, analyzing, and resolving insurance claim denials with accuracy and persistence.
You will work within a structured remote environment where attention to detail and strong analytical skills directly impact reimbursement outcomes for healthcare providers.
The position involves reviewing payer correspondence, explanation of benefits (EOBs), and billing forms to determine the appropriate appeal or resolution pathway.
You will actively communicate with insurance payers to negotiate claim resolutions and ensure timely follow-up on outstanding accounts.
A key part of the role includes preparing and submitting appeals with supporting documentation, including medical records and clinical input when needed.
You will track account progress, document outcomes, and help drive recovery of denied or underpaid claims.
This is a fast-paced, detail-driven role that plays a critical part in improving financial performance across healthcare organizations.

• 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.

• 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.

• 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 cycle operations.
• Stable weekday schedule (Monday–Friday, standard business hours).
• Exposure to advanced healthcare billing, denial management, and payer negotiation processes.