Central Denials Account Representative – Hospital, Onsite

Guidehouse; Birmingham (AL); On-site; USD 32,000 - 42,000; Full time

Job summary

Guidehouse is seeking a Central Denials Account Representative in the United States to perform comprehensive account reviews and resolve insurance claim denials and balances. You will handle UB04 and 1500 files, perform non-clinical appeals, and collaborate with supervisors on complex issues.

The role emphasizes strong written and verbal communication, ability to work independently, and cross-department coordination to ensure timely patient account resolution.

Qualifications

• 0-2 years medical billing experience with UB04, appeals & denials.
• Ability to interpret reimbursement aspects of managed healthcare contracts.
• Excellent customer service and problem-solving skills.

Responsibilities

• Conduct account reviews to resolve denials and balances.
• Make outbound calls to Insurance Companies to resolve claim denials.
• Escalate payer issues to a supervisor.
• Communicate with other departments to ensure proper handling of patient accounts.
• Resubmit corrected claims and supporting documentation as needed.

Job description

++Job Family++:
Patient Account Representative

++Travel Required++:
None

++Clearance Required++:
None ++What You Will Do++: The Central Denials Account Representative conducts thorough account reviews to determine the appropriate action needed to resolve the account balance. This includes reviewing and performing the following:

• 227 Electronic Files
• 835 Electronic Files
• UB04's and 1500 Claim Files
• Medical Record
• Making outbound calls to Insurance Companies to resolve claim denials and account balances.
• Performing Non-Clinical Appeals.
• Assisting Supervisor/Manager as needed with various projects.
• Escalate payer issues/trends to a supervisor with the appropriate information or take appropriate action so that the issue expert can effectively resolve the matter.
• Communicate to Supervisor/Manager areas of concern or areas of improvement.
• Resubmit Corrected Claims and supporting documentation as need for the patient experience.
• Communicate with other organizational departments to ensure proper handling of patient accounts.
• Communicates issues to management timely and performs other duties as assigned by direct supervisors.
• Perform a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure.
• Ability to initiate and follow through on projects and work independently with minimal supervision required.
• Good written and verbal communications skills

++What You Will Need++:

• HS Diploma or equivalent.
• 0-2 years medical billing experience working with UB04, appeals & denials.

++What Would Be Nice to Have++:

• Ability to interpret and apply reimbursement aspects of managed healthcare contracts.
• Exceptional customer service skills including effective and efficient problem solving and analyzing skills.

++What We Offer++:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

++About Guidehouse++

Guidehouse is an Equal Opportunity Employer-Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse's Ethics Hotline. If you want to check the validity of correspondence you have received, please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant's dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.