EvergreenHealth

Denial Management Specialist

EvergreenHealth  •  $46.14/hr  •  Kirkland, WA (Onsite)  •  2 months ago
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Job Description

Wage Range: $28.83 - $46.14 per hour
Healthcare medical billing and reimbursement 
Remote in Washington State onlyPosted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

 Responsible for the review, appeal strategy, resolution and reporting of payer claim denials to recover reimbursement for EvergreenHealth. Maintains accountability for final appeal determinations and financial outcomes of assigned denials, including validation of triage decisions and direction of appeal activities. Analyzes denial trends, develops appeal strategies, collaborates with clinical and operational departments, and maintains detailed documentation throughout the appeal lifecycle. Communicates with payer representatives, contributes to denial prevention efforts, and adapts to evolving payer policies and system upgrades.

Primary Duties:  1. Reviews and validates recommended next steps for referred claim denials. Maintains final responsibility for appeal strategy and financial outcome.2. Maintains accurate documentation of denial activity and appeal actions in electronic medical record (EMR) system and supporting tools.3. Develops appeal strategy and drafts and submits timely appeals supported by documentation, clinical input, and payer criteria.4. Collaborates with departments including Case Management, Coding, and Health Information Management (HIM) to gather supporting documentation that will strengthen the appeals.5. Refers complex or escalated denials to senior team members or leadership as appropriate.6. Reviews and validates denial trends and communicates payer feedback to promote consistency in documentation, appeal strategy, and resolution processes.7. Monitors payer websites for changes in reimbursement requirements that impact denial management processes.8. Participates in training focused on denial trends, payer-specific appeal strategies, and continuous learning around EMR tools.9. Performs other duties as assigned.
License, Certification, Education or Experience:
REQUIRED for the position:● Associate's degree in related area or equivalent combination of education and experience● 5 years of experience in denial management, utilization review or prior authorization in a hospital, provider, or healthcare system.● Experience in healthcare billing and reimbursement● Experience with EMR system workflows● Strong knowledge of health care services reimbursement methodologies● Knowledge of claim forms and remittance advices, including coding and billing practices● Ability to interpret contract language● Working knowledge of medical terminology
DESIRED for the position:● Bachelor's degree● Previous training experience and knowledge of adult learning● Experience with Epic EMR
Benefit Information:
Choices that care for you and your family   At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.  
  • Medical, vision and dental insurance 
  • On-demand virtual health care 
  • Health Savings Account 
  • Flexible Spending Account 
  • Life and disability insurance 
  • Retirement plans (457(b) and 401(a) with employer contribution) 
  • Tuition assistance for undergraduate and graduate degrees 
  • Federal Public Service Loan Forgiveness program 
  • Paid Time Off/Vacation 
  • Extended Illness Bank/Sick Leave 
  • Paid holidays 
  • Voluntary hospital indemnity insurance 
  • Voluntary identity theft protection 
  • Voluntary legal insurance 
  • Pay in lieu of benefits premium program 
  • Free parking 
  • Commuter benefits  
View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below. 
EvergreenHealth Benefits Guide  
EvergreenHealth

About EvergreenHealth

EvergreenHealth, a public hospital district and community-owned health care system established in 1972, offers a breadth of services and programs that is among the most comprehensive in the region.

With two hospitals in Kirkland and Monroe and dozens of practices across the region, we serve more than 1 million of our service area in north King and south Snohomish counties, ensuring access close to home and work.

Our 1,100+ physicians provide the most advanced and personalized care with more than 80 primary and specialty services, giving all of our patients a highly collaborative, compassionate experience every time they walk through our doors.

As a public hospital district, EvergreenHealth’s resources and services are in part funded by our community, which means we are accountable to you and everyone we serve. The community’s support allows us to go beyond clinical care and offer community health outreach, education programs and free services like our Healthline, which connects you with a 24/7 consulting nurse service, health information, appointment scheduling assistance, class registration, and more.

For more information, visit: https://www.evergreenhealth.com/

Industry
Healthcare & Social Services
Company Size
1,001-5,000 employees
Headquarters
Kirkland, WA
Year Founded
1972
Website
evergreenhealth.com
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