Denial Management Specialist

Description

Wage Range: $28.26 - $45.23 per hour

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

Job Summary:

Responsible for the identification, appeal, resolution and reporting of all third-party payer claim denials to recover reimbursement for EvergreenHealth. Accountable for analyzing denial trends, developing appeal strategies, collaborating with clinical and operational departments, and maintaining detailed documentation throughout the appeal lifecycle. The Denial Management Specialist communicates with payer representatives, contributes to denial prevention efforts, and adapts to evolving payer policies and Epic system upgrades.

Primary Duties:

• Reviews and prioritizes payer claims denials using Epic work queues based on deadlines, financial impact, and overturn potential.
• Maintains accurate documentation of denial activity and appeal actions in Epic and supporting tools.
• Drafts and submits timely appeals supported by documentation, clinical input, and payer criteria.
• Collaborates with departments including Case Management, Coding, and Health Information Management (HIM) to gather supporting documentation that will strengthen the appeals.
• Refers complex or escalated denials to senior team members or leadership as appropriate.
• Communicates denial trends and payer feedback to team members and leadership to promote consistency in documentation, appeal strategy, and resolution processes.
• Monitors payer websites for changes in reimbursement requirements that impact denial management processes.
• Participates in training focused on denial trends, payer-specific appeal strategies, and continuous learning around Epic tools.
• Performs other duties as assigned.

License, Certification, Education or Experience:

REQUIRED for the position:

• Associate's degree in related area or equivalent combination of education and experience
• 3 years of experience in a hospital or insurance industry setting
• High degree of knowledge regarding health care services reimbursement methodologies
• Knowledge of claim forms and remittance advices including coding and billing practices
• Experience in healthcare billing and reimbursement
• Ability to interpret contract language
• Working knowledge of medical terminology

DESIRED for the position:

• Bachelor's degree
• Experience with electronic medical record (EMR) system workflows

Benefit Information:

Choices that care for you and your family

At EvergreenHealth, we appreciate our employees' commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

• Medical, vision and dental insurance
• On-demand virtual health care
• Health Savings Account
• Flexible Spending Account
• Life and disability insurance
• Retirement plans (457(b) and 401(a) with employer contribution)
• Tuition assistance for undergraduate and graduate degrees
• Federal Public Service Loan Forgiveness program
• Paid Time Off/Vacation
• Extended Illness Bank/Sick Leave
• Paid holidays
• Voluntary hospital indemnity insurance
• Voluntary identity theft protection
• Voluntary legal insurance
• Pay in lieu of benefits premium program
• Free parking
• Commuter benefits

View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.

EvergreenHealth Benefits Guide