Denials Resolution Representative

TeamHealth is proud to be the leading physician practice in the U.S. providing exceptional patient care, together. Newsweek Magazine recognizes TeamHealth ‘as one of the greatest workplaces for diversity and one of the greatest workplaces for women; 2024-2025’. Becker’s Hospital Review names TeamHealth among the top 150 places to work in healthcare. We continue to grow across the country from our Clinicians to Corporate Employees. Join us!

What we Offer:

• 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

OVERVIEW:

The Denials Resolution Representative is responsible for reviewing various carrier denials at their assigned Billing Group and submitting appeals accordingly. Maintains accuracy and production to ensure invoices are being processed efficiently.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Reviews ETM task list assignment, comments, and rebills/appeals claim as necessary
• Reviews denials to determine appropriate action based on carrier requirements
• Posts appropriate rejection codes into system where applicable
• Obtains status by establishing carrier contact if the submitted appeal has yielded no response
• Identifies and forwards documentation to appeal disputed claims
• Assembles and forwards appropriate documentation to the senior representative for provider and carrier related issues
• Reviews carrier provider manuals for billing updates as needed
• Reports any consistent errors found during review that affect claims from being processed correctly
• Participates in department meetings with Accounts Receivable Team
• Identifies trends in claims filed outside carrier timely filing deadlines and offers suggestions to prevent future occurrences
• Turns to Senior/Supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc.
• Performs any and all duties as directed by Senior Representative, Supervisor, and Accounts Receivable Manager

QUALIFICATIONS / EXPERIENCE:

• 1 year medical billing experience
• Knowledge of physician billing policies and procedures
• Computer literate
• Ability to work in a fast-paced environment
• Excellent organizational skills
• Ability to work independently
• High School diploma or equivalent