Denials Management Specialist | Patient Accounting | Full Time (On-Site)

Gritman Medical Center, Inc.; Moscow (ID); On-site; USD 65,000 - 90,000; Full time

Job summary

Gritman Medical Center, Inc. in Moscow, ID is seeking a Denials Management Specialist to join the Patient Accounting team on-site. You will analyze, prevent, and resolve claim denials across CAH, specialty clinics, and RHC settings using Epic revenue-cycle tools.

Responsibilities include managing denials and appeals, researching root causes, collaborating with clinical and billing staff, and developing corrective-action plans to improve clean-claim performance and timely reimbursement.

Qualifications

• Three years of progressively responsible experience in hospital revenue cycle, denials management, or related function.
• Experience with CAH, RHC, and/or specialty clinic operations preferred.
• Experience handling denials, corrections, reconsiderations, appeals, and timely filing.
• Knowledge of Medicare, Medicaid, commercial payer policies and denial processes.
• Hands-on use of Epic for denial management, research, workflow, and reporting.
• Proficiency in Excel (sorting, filtering, pivot tables) and MS Office.

Responsibilities

• Review and resolve denials, underpayments, and appeals in Epic within set work queues and deadlines.
• Research denial root causes using documentation, coding, and payer policies.
• Prepare, submit, and track corrected claims, reconsiderations, and appeals.
• Maintain complete denial activity documentation in Epic and other systems.
• Monitor denial volumes, dollars, rates, and performance metrics.
• Collaborate across departments to develop corrective-action plans.
• Participate in workflow design and post-implementation reviews.
• Educate departments on denial causes and process improvements.
• Protect confidential information and ensure compliance with policies.

Skills

Analytical thinking

Communication skills

Organizational skills

Team collaboration

Independent work

Education

Associate or Bachelor’s in healthcare administration, business, accounting, finance, or health information management

Tools

Epic Hospital Billing

Epic Professional Billing

Excel

Reporting Workbench

Slicer Dicer

Job description

Denials Management Specialist | Patient Accounting | Full Time (On-Site)

Requisition Number: DENIA004090

• Posted : October 13, 2026
• Full-Time

Locations

Showing 1 location

Gritman Medical Center, Inc.
Moscow, ID 83843, USA

Description

The Denials Management Specialist is responsible for analyzing, resolving, preventing, and reporting claim denials and related revenue-cycle issues across Critical Access Hospital (CAH), specialty clinic, and Rural Health Clinic (RHC) settings. This position manages denial and appeal follow-up; identifies root causes and trends; collaborates with operational, clinical, coding, billing, registration, contracting, and information services teams; and recommends corrective actions to reduce avoidable denials, improve clean-claim performance, support compliant charge capture, and maximize appropriate reimbursement.

The Specialist supports revenue integrity through analysis of denial patterns, charge-capture and reconciliation processes, unbilled and discharged-not-final-billed accounts, claim edits, payer requirements, and hospital and clinic billing workflows. The position uses Epic revenue-cycle tools and reporting capabilities to prioritize work, document outcomes, prepare timely operational and leadership reports, and support cross-functional process-improvement initiatives.

Essential Functions

• Review and resolve assigned hospital, CAH, RHC, specialty clinic, and professional billing denials, underpayments, claim edits, and appeal opportunities in Epic within established work-queue, filing-limit, and follow-up requirements.
• Research denial root causes using patient-account documentation, clinical documentation, coding, charge capture, authorization, registration, payer correspondence, contracts, and applicable payer policies.
• Prepare, submit, and track corrected claims, reconsiderations, appeals, supporting documentation, and other payer-required correspondence within applicable filing deadlines.
• Maintain complete, accurate, and timely documentation of denial activity, payer contacts, appeal status, outcomes, recoveries, write-offs, and next steps in Epic and other designated systems.
• Monitor and report denial volumes, dollars, denial rates, appeal outcomes, avoidable-denial trends, write-offs, overturn rates, recovery activity, aging, and payer-specific performance.
• Identify recurring denial causes and collaborate with Patient Access, Patient Financial Services, Health Information Management, coding, clinical departments, utilization review, case management, contracting, and other operational areas to develop and implement corrective-action plans.
• Participate in revenue-integrity reviews related to charge capture, charge reconciliation, charge-description-master maintenance, claim edits, billing logic, professional fee schedules, and documentation processes, as assigned.
• Support daily and periodic review of unbilled, DNFB, charge-lag, and other revenue-cycle work queues; identify barriers to timely billing; and coordinate resolution with responsible departments.
• Maintain working knowledge of payer medical policies, billing requirements, authorization and notification requirements, appeal processes, timely‑filing rules, coding and documentation requirements, and relevant contractual provisions.
• Prepare concise denial‑management dashboards, ad hoc analyses, written findings, and recommendations for the Director of Patient Accounting, Executive Director of Revenue Cycle, department leaders, and other stakeholders.
• Participate in workflow design, testing, education, and post‑implementation review of revenue‑cycle, payer, and system changes that affect charge capture, claim submission, denials, payment, and reimbursement.
• Provide education and feedback to departments regarding recurring denial causes, documentation requirements, charge‑capture issues, payer requirements, and process‑improvement opportunities.
• Protect confidential information and access, use, and disclose protected health information only as necessary to perform assigned job duties and in accordance with organizational policy and applicable law.
• Escalate potential compliance concerns, material payer disputes, systemic reimbursement issues, suspected billing inaccuracies, and trends with significant financial impact to leadership in a timely manner.
• Perform other duties consistent with the scope and purpose of the position.

Performance Expectations

• Timely resolution of assigned denials and appeals.
• Compliance with payer and contractual filing deadlines.
• Dollar value of denials overturned, corrected, rebilled, or otherwise recovered.
• Reduction in preventable denial volume and value for assigned denial categories.
• Appeal success rate and write‑off prevention rate.
• Accuracy and completeness of denial documentation and reporting.
• Timeliness of escalation of material payer, workflow, or compliance concerns.
• Completion and effectiveness of assigned corrective‑action plans.

Required Qualifications

• High school diploma or equivalent.
• Three years of progressively responsible experience in hospital or physician revenue cycle, patient accounting, medical billing, claims follow‑up, denials management, reimbursement, coding, or a related healthcare‑finance function. Experience supporting CAH, RHC, and/or specialty clinic operations is strongly preferred.
• Experience working hospital and/or professional claims, payer denials, corrections, reconsiderations, appeals, and timely‑filing requirements.
• Working knowledge of Medicare, Medicaid, commercial payer, managed‑care, authorization, medical‑necessity, coordination‑of‑benefits, eligibility, coding, and documentation‑related denial processes, as applicable to the organization.
• Hands‑on experience using Epic for denial management, account research, work‑queue management, claim correction, appeal tracking, documentation, and revenue‑cycle reporting.
• Intermediate proficiency in Microsoft Excel, including sorting, filtering, formulas, pivot tables, and basic data analysis; proficiency in Word, Outlook, and PowerPoint.
• Ability to analyze data, identify trends and root causes, prioritize workload, meet deadlines, prepare professional written correspondence, and communicate effectively with clinical, operational, financial, and payer stakeholders.
• Ability to work independently while collaborating effectively across departments.

Preferred Qualifications

• Associate or bachelor’s degree in healthcare administration, business, accounting, finance, health information management, or a related field.
• Five or more years of hospital revenue‑cycle, revenue‑integrity, denials‑management, billing, coding, reimbursement, or managed‑care experience.
• Advanced experience with Epic Hospital Billing and Professional Billing, including claim edits, work queues, Reporting Workbench, and Slicer Dicer reporting tools.
• Experience managing denials and reimbursement workflows across Critical Access Hospital, Rural Health Clinic and specialty clinic environments, including familiarity with distinct payer, billing, coding, and documentation requirements.
• Experience with charge‑description‑master review, charge capture, charge reconciliation, DNFB management, or hospital revenue integrity.
• Experience interpreting managed‑care agreements, payer policies, payment methodologies, and reimbursement terms.
• HFMA certification or relevant revenue‑cycle, coding, compliance, or health‑information credential.
• Lean, Six Sigma, or other process‑improvement training or experience.

Knowledge, Skills, and Abilities

• Strong analytical, investigative, problem‑solving, organizational, and prioritization skills.
• Strong written communication skills, including the ability to prepare persuasive and factually supported appeal letters.
• Ability to interpret payer correspondence, remittance advice information, claim edits, financial data, and operational reports.
• Ability to communicate denial trends and corrective recommendations clearly to both technical and nontechnical audiences.
• Attention to detail and ability to manage multiple accounts, priorities, deadlines, and follow‑up requirements.
• Sound judgment in handling confidential information, escalating risks, and identifying potential compliance concerns.
• Demonstrated commitment to customer service, collaboration, accountability, continuous improvement, and respectful workplace conduct.

Equal Opportunity Employer
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