Denials & Appeals Specialist — Revenue Cycle

Torrance Memorial; Torrance (CA); On-site; USD 36,000 - 54,000; Full time

Job summary

Torrance Memorial is seeking a Denials Patient Account Representative who will review denied claims and lead the appeals process under the Director of Revenue Cycle. The role involves working with third-party payers, tracking denials, and performing research to resolve issues efficiently.

Knowledge of payer-specific billing, contracts, and appeals is essential, along with the ability to prepare reports and collaborate with internal teams to improve cash flow and reduce denials.

Qualifications

• Bachelor's degree in business, healthcare, or related field or Associate's degree with 3 years of patient financial services.
• 2 years of healthcare billing, collections, payment processing or denials management.
• Knowledge of state/federal laws related to contracts and to the appeals process.
• Proficiency with hospital contract management systems.

Responsibilities

• Review denied claims and carry out the appeals process with third-party payers.
• Respond to inquiries and maintain third-party relationships.
• Track the status of denials and appeals; generate reports for revenue cycle oversight.
• Collaborate with internal departments to resolve issues and improve processes.
• Identify improvement opportunities and support system testing with IT.

Skills

Denials management

Appeals processing

Payer communications

Research on denials

Workflow prioritization

Customer service

Team collaboration

Education

Bachelor's degree

Associate's degree with 3 years experience

Tools

Contract management system

Job description

Torrance Memorial is seeking a Denials Patient Account Representative who will review denied claims and lead the appeals process under the Director of Revenue Cycle. The role involves working with third-party payers, tracking denials, and performing research to resolve issues efficiently.

Knowledge of payer-specific billing, contracts, and appeals is essential, along with the ability to prepare reports and collaborate with internal teams to improve cash flow and reduce denials.