Reimbursement Denials Representative

Job Type: Full Time
Job Location: Albuquerque



Remote possibility after training

Applicants offered positions must show proof of COVID vaccination or provide a religious exemption and agree to weekly testing

Denials Representative is responsible for tracking, appealing, and resolving denied claims to ensure timely and accurate reimbursement for all billed charges. Performs a variety of duties including accounts receivable follow-up, customer service, correspondence response and daily reconciliation of assigned denial activities.

Basic Qualifications

  • High school diploma or equivalent
  • Three to five years of relevant experience

Preferred Skills/Experience

  • Perform research of denials and unpaid claims assigned, making appropriate corrections including phone calls, claims resubmission, appeal, or reconsideration. All denied claims are worked to resolution defined as payment recovery, transfer to patient responsibility, or write off as appropriate.
  • Process payor communications and correspondence.
  • Work front end rejections, stop hold, billing review, and unsubmitted claims.
  • Ensure all job functions are performed within the established quality and quantity standards by maximizing cash recovery on denials and ensure monthly collection goals are achieved.
  • Demonstrate a working knowledge medical terminology, CPT, HCPCS, and ICD10 coding. Knowledge of healthcare contractual obligations, payer policies and procedures such as claim filing limits, medical necessity and dual coverage.
  • Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution
  • Knowledge of pertinent Federal, State, and local laws, codes, and regulations related to patient billing and collection.


Apply for this position

Allowed Type(s): .pdf, .doc, .docx