Remote Physician Denials Specialist

Remote Physician Denials Specialist - 248391

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$23.00/hr - $31.00/hr

Full-Time | Remote (with location restrictions)

Healthcare Revenue Cycle | Denials | Appeals | EPIC PB

A leading healthcare organization is seeking a Professional Billing (PB) Denials & Appeals Analyst to support its Revenue Cycle team. This position focuses on denial research, root‑cause analysis, payer disputes, and written appeals—not traditional A/R follow‑up. The ideal candidate is analytical, detail‑oriented, and experienced in EPIC PB workflows.

The PB Denials & Appeals Analyst is responsible for investigating claim denials, identifying the root cause, completing payer disputes and appeals, and communicating directly with payers to ensure appropriate reimbursement. This role requires strong knowledge of payer policies, Medicare/Medicaid rules, and EPIC PB workflows.

• Review and analyze claim denials to determine what happened, why it happened, and how to prevent recurrence.
• Identify internal process issues and trends contributing to denials.
• Perform root cause analysis based on payer policies, system workflows, and documentation requirements.

• Draft clear, accurate, and persuasive non-clinical appeal letters.
• Submit payer disputes through appropriate portals or platforms.
• Follow up on the status of appeals and disputes via calls and electronic communication.
• When a denial is upheld, dispute further by directly calling the payer.
• Work EPIC PB work queues (no A/R follow-up responsibilities).
• Maintain productivity standards—
  target: 7 accounts per hour after 90‑day ramp‑up period.
• Track and report weekly productivity metrics.
• Use trend analysis to identify ongoing payer issues and elevate as needed.

• Use Jabber (computer‑based calling; no personal phone required) for payer communication.
• Navigate payer portals with ease to submit appeals, gather information, and research policies.
• Collaborate with internal revenue cycle teams as needed.
• Choose between:
  Remote with occasional restrictions based on state regulations.
• Standard weekday schedule; productivity judged weekly.
• 90‑day ramp‑up period for onboarding and acclimation.

• 3–5 years of EPIC Professional Billing (PB) experience
• This requirement is strict; less than 3 years is not eligible.
• Strong root cause analysis experience (payer policies, internal workflows, denial trends).
• Experience writing payer appeals (non‑clinical; timely filing disputes).
• Extensive experience with payer portals.
• Knowledge of Medicare and Medicaid billing/denial rules.

• Prior experience in a large healthcare system
• Experience with complex denial trends
• Familiarity with HB processes (not required)

• Works efficiently in EPIC PB work queues
• Analyzes denials quickly and accurately
• Understands payer policies and reimbursement rules
• Excels in trend analysis and process improvement
• Communicates confidently with payers
• Highly analytical and detail‑oriented
• Able to independently identify patterns and trends
• Comfortable navigating systems and payer portals
• Adaptable and calm under pressure

Seniority level:
Associate

Employment type:

Full-time

Job function:
Administrative

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