Denials Representative

A Denials Representative is responsible for reviewing and resolving denied hospital insurance claims to ensure proper reimbursement. This role researches denial reasons, contacts insurance companies, submits appeals, and follows up on outstanding claims until payment is received. The Denials Representative works closely with hospital revenue cycle and collections teams, identifies denial trends, and reports findings to leadership to help improve reimbursement processes and reduce future denials.

• Research denied claims and determine root causes
• Contact insurance carriers regarding claim status and payment issues
• Prepare and submit appeals with supporting documentation
• Follow up on denied or underpaid claims until resolution
• Track denial trends and identify recurring issues
• Collaborate with revenue cycle teams to maximize reimbursement
• Report findings and recommendations to leadership