Revenue Cycle Specialist II — Denials & Payer Resolution

Jefferson Health; Willow Grove (PA); Hybrid; USD 52,000 - 65,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

Tuition assistance

Retirement plans

Job summary

Jefferson Health is seeking a Revenue Cycle Representative II to review and resolve complex claim denials. You will interact with payers, hospital departments, and patients to obtain information necessary for effective denial resolution.

The role requires navigating authorizations, rebilling, and appropriate balance adjustments while adhering to regulatory guidelines. Qualified candidates have 3+ years in hospital revenue cycle, familiarity with Epic, and strong communication skills.

Qualifications

• High school diploma or GED required; associate or bachelor’s degree preferred.
• Minimum 3 years in hospital revenue cycle.
• Experience with Epic preferred.
• Knowledge of state and federal billing guidelines.

Responsibilities

• Review and resolve complex denial cases by coordinating with payers, hospital teams, and patients.
• Develop denial strategies including authorization research, rebilling, and balance write-offs or transfers.
• Communicate with third-party payers and hospital departments to obtain needed information for denial resolution.
• Reference payer policies to troubleshoot denial issues and improve resolution techniques.
• Maintain understanding of regulations governing appeals and follow-up.

Skills

Communication skills

Denial analysis

Teamwork

Organizational skills

Education

High school diploma or GED

Associate or Bachelor's degree preferred

Tools

Epic

Microsoft Office

Windows 10

Job description

Jefferson Health is seeking a Revenue Cycle Representative II to review and resolve complex claim denials. You will interact with payers, hospital departments, and patients to obtain information necessary for effective denial resolution.

The role requires navigating authorizations, rebilling, and appropriate balance adjustments while adhering to regulatory guidelines. Qualified candidates have 3+ years in hospital revenue cycle, familiarity with Epic, and strong communication skills.