Denials Management Specialist

Denials Management SpecialistFT, DaysGrand River Health | Rifle, CO

At Grand River, we are more than a hospital - we are neighbors taking care of neighbors proudly serving residents of Western Colorado and beyond. Our supportive culture is built on respect, friendliness, and a shared commitment to exceptional patient care.

What You’ll Do

The Denials Management Specialist is responsible for identifying, investigating, appealing, and resolving denied or underpaid insurance claims to maximize reimbursement and minimize revenue loss. This role works closely with billing, coding, patient financial services, and clinical departments to ensure timely resolution of claim denials, identify root causes, and support process improvements that enhance revenue cycle performance.

• Review, prioritize, and investigate denied, rejected, and underpaid claims from government and commercial payers to determine appropriate resolution strategies.
• Prepare, submit, and monitor appeals while following payer guidelines, regulatory requirements, and organizational policies.
• Collaborate with billing, coding, registration, authorization, patient financial services, and clinical teams to obtain documentation and resolve claim issues.
• Communicate with insurance carriers regarding claim status, payment discrepancies, appeal outcomes, and reimbursement concerns.
• Analyze denial trends, generate reports, and identify root causes impacting reimbursement and revenue cycle performance.
• Recommend and support process improvements, staff education, and denial prevention initiatives to improve clean claim rates and financial outcomes.
• Maintain accurate documentation of denial activity while meeting established productivity, quality, and departmental standards, and participate in ongoing training and improvement efforts.

Who We’re Looking For

We're seeking a detail-oriented and analytical professional who is passionate about resolving complex reimbursement issues and improving revenue cycle outcomes. The ideal candidate thrives in a fast-paced environment, communicates effectively across departments, and can balance multiple priorities while maintaining accuracy and confidentiality. They bring a strong understanding of payer requirements and healthcare billing processes, along with a collaborative approach to problem-solving and continuous improvement.

• High school diploma or equivalent required; Associate degree in Healthcare Administration, Business Administration, Health Information Management, or a related field preferred.
• Two (2) years of experience in healthcare revenue cycle operations, medical billing, accounts receivable, denial management, or a related healthcare financial role preferred.
• Working knowledge of healthcare revenue cycle processes, insurance claim adjudication, reimbursement methodologies, and payer regulations, including Medicare, Medicaid, commercial insurance, and managed care requirements.
• Understanding of CPT, ICD-10-CM, and HCPCS coding principles and their impact on reimbursement and claim resolution.
• Proficiency with electronic health records (EHRs), patient accounting and revenue cycle systems, Microsoft Office applications, and the ability to become proficient in organizational software systems within six (6) months of hire.
• Strong analytical, organizational, and problem-solving abilities with the capacity to interpret payer guidelines, analyze financial information, and determine appropriate courses of action.
• Excellent verbal and written communication skills, attention to detail, sound judgment, and the ability to work independently and collaboratively while managing multiple priorities and deadlines.

What We Offer

Our total rewards package includes:

• Pay Range: $29.42 --$42.02/hour (based on experience)
• Comprehensive Benefits: Medical, dental, vision, PTO from day one, extended illness time, retirement plan with match, and more.
• Perks: Payroll deductions for hot springs, gyms, ski passes, pet insurance, access to outdoor recreation, and more!

Compensation may vary outside this range depending on a number of factors, including a candidate’s qualifications, skills, competencies and experience.

Position is open until filled unless posted otherwise.

Why Join Grand River Health?As a special taxing district, we are accountable to our community, allowing us to prioritize exceptional patient-centered care over financial bottom lines. Our main hospital campus is located in picturesque Rifle, Colorado with twenty-five beds providing a wide range of services, along with a long-term care center and a satellite campus. While the secret is out that this is a great place to live, the atmosphere of a caring and friendly community has been preserved amidst a steady growth of population.

OUR MISSION:To improve the health and well-being of the communities we serve.

OUR VISION:To be our communities’ first choice in quality healthcare.