Patient Account Rep, Denials POST NUMBER: 480013

Patient Account Representative, Denials

Overview

We are placing a Denials Patient Account Representative on behalf of a well-established community hospital in the South Bay area. This is a temporary engagement with strong potential for extension and conversion to a permanent role. Reporting to the Director of Revenue Cycle, this person will be responsible for working and appealing commercial insurance denials and supporting the broader revenue cycle team. The organization is actively building out a dedicated denials function, making this a great opportunity to grow within a high-performing team.

Key responsibilities

• Execute the full denial appeals process including receiving, assessing, documenting, tracking, and resolving appeals with third-party payers
• Analyze denial reason codes and determine appropriate appeal strategy for each claim
• Draft and submit formal written appeals within payer-required timelines
• Utilize the hospital's contract management system to identify accounts paid below expected reimbursement
• Maintain data on denial types and root causes and collaborate with team members on process improvements
• Interpret patient insurance benefit information and explain payer determinations clearly
• Prepare and assist with reports as required by management
• Partner with internal departments and external organizations to resolve outstanding appeals

Qualifications and requirements

• Minimum 2 years of experience in healthcare billing, collections, or denials management
• Bachelor's degree in business, healthcare, or a related field; or Associate's degree with 3 years of patient financial services experience
• Hospital-specific background required; physician group or clinic-only experience will not be considered
• Strong working knowledge of commercial payer contracts, appeal timelines, and denial codes
• Experience writing and submitting successful payer appeals
• Proficiency in Oracle Splash preferred; Epic or equivalent revenue cycle software acceptable
• Knowledge of state and federal regulations related to billing and the appeals process
• Ability to work on-site five days per week in Torrance