Denials Representative

External Job Description And Responsibilities

Team Health is proud to be the leading physician practice in the U.S. providing exceptional patient care, together. Team Health has been recognized by Newsweek as one of America’s Greatest Workplaces in Health Care for 2025 – Becker’s Hospital Review names Team Health among the top 150 places to work in healthcare. We continue to grow across the U.S. from our Clinicians to Corporate Employees.

Join us!

• Career Growth Opportunities
• A Culture anchored in a strong sense of belonging
• Benefits (Medical/Dental/Vision) begin the first of the month following 30 days of employment
• 401k (Discretionary match)
• Generous PTO
• 8 Paid Holidays
• Equipment Provided for Remote Roles

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

• 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

• 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

None

• Job performed in a well-lighted, modern office setting
• Occasional standing/bending
• Occasional lifting/carrying (20lbs or less)
• Moderate stress
• Prolonged sitting
• Prolonged work on a PC/computer
• Prolonged telephone work
• This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions
• May require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week

Remote

Admin-Clerical, Administrative, Healthcare