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Denial Representative Jobs (NOW HIRING)

Evergreen Health

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

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 ...

EvergreenHealth

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

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 ...

EvergreenHealth

Denial Management Specialist

Kirkland, WA · On-site

$28.83 - $46.14/hr

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 ...

RSI

Denial Resolution Specialist

Glendale, AZ · On-site

$17/hr

... representatives, adeptly navigating conversations to untangle the complexities of denial issues • Adhere meticulously to industry regulations, including but not limited to HIPAA, TCPA, and other ...

Vital Connect Inc

Denial Management Specialist

CA · Remote

... company representatives, patients, physicians, and practice staff. Execute the denial appeals process which includes receiving, accessing, documenting, tracking, responding to, and/or resolving ...

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Denial Representative information

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$24.5K

$44.2K

$77K

How much do denial representative jobs pay per year?

As of May 30, 2026, the average yearly pay for denial representative in the United States is $44,219.00, according to ZipRecruiter salary data. Most workers in this role earn between $37,500.00 and $43,000.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Denial Representative, and why are they important?

To thrive as a Denial Representative, you need a solid understanding of medical billing, insurance processes, and claims adjudication, often supported by experience in healthcare administration or a related field. Familiarity with claims management software, electronic health records (EHRs), and payer-specific portals is essential. Strong attention to detail, problem-solving abilities, and effective communication skills help resolve denied claims efficiently and interact with payers and providers. These skills ensure accurate claims resolution, maximize reimbursement, and maintain positive relationships within the revenue cycle.

What are some common challenges faced by Denial Representatives and how can they be managed effectively?

Denial Representatives often encounter challenges such as managing high volumes of denied claims, navigating complex insurance policies, and communicating with both healthcare providers and payers. Staying organized and detail-oriented is crucial to ensure accurate documentation and timely follow-up. Building strong problem-solving skills and maintaining up-to-date knowledge of payer guidelines can help overcome these challenges. Collaboration with billing teams and proactive communication with insurance companies also play a key role in resolving denials efficiently.

What are Denial Representatives?

Denial Representatives are professionals who work in healthcare organizations, insurance companies, or third-party billing services to review, analyze, and handle insurance claims that have been denied. Their responsibilities typically include investigating the reasons for claim denials, communicating with insurance providers and healthcare providers, and working to resolve issues so that claims can be paid. They may also appeal denied claims by gathering necessary documentation and ensuring compliance with policies and regulations. Denial Representatives play a key role in ensuring that healthcare providers receive proper reimbursement and that patients' insurance claims are processed accurately.

What is the difference between Denial Representative vs Claims Processor?

AspectDenial RepresentativeClaims Processor
CredentialsInsurance knowledge, sometimes certificationsBasic insurance or administrative training
Work EnvironmentInsurance companies, healthcare providersInsurance companies, healthcare facilities
Primary RoleReview and appeal denied claimsProcess and input claims data

While both roles work within the insurance claims process, a Denial Representative focuses on managing denied claims, appealing decisions, and resolving disputes. A Claims Processor handles the initial processing of claims, entering data, and ensuring claims are correctly submitted. Understanding these differences helps job seekers identify the right position based on their skills and career goals.

More about Denial Representative jobs
What job categories do people searching Denial Representative jobs look for? The top searched job categories for Denial Representative jobs are:
Denial Representative jobs near you
Infographic showing various Denial Representative job openings in the United States as of May 2026, with employment types broken down into 25% Full Time, 25% Temporary, and 50% Contract. Highlights an 10% Physical, 10% Hybrid, and 80% Remote job distribution, with an average salary of $44,219 per year, or $21.3 per hour.
Insurance Denial Specialist

Insurance Denial Specialist

St. Joseph's/Candler

Savannah, GA • On-site

$19.28/hr

Full-time

Posted 16 days ago

St. Joseph's/Candler Health System rating

6.0

Company rating: 6.0 out of 10

Based on 17 frontline employees who took The Breakroom Quiz

Job description

  • Position Summary
    • The Denial Specialist will be responsible for coordinating appeals and collection efforts for denied/underpaid services performed at St. Joseph’s/Candler and its affiliates where applicable. The scope of work will encompass all Government, Commercial and Managed Care payers, and include all service lines and all denial types. Position will be a liaison with other departments, physicians and other clinicians within and outside the organization in order to facilitate timely and accurate submission and processing of appeals. The Denial Specialist will work closely with management, precertificiation, insurance verification, and operations to ensure trends are identified and corrected to reduce denials.
  • Education
    • Associates - Preferred
  • Experience
    • 2-3 Years medical background - Preferred
    • 1-2 Years insurance, oncology billing and/or denial management experience - Preferred
  • License & Certification
    • None Required
  • Core Job Functions
    • Demonstrates responsibility in maintaining patient records in organized and secure manner. Ensures HIPAA regulations are continuously followed.
    • Meets monthly departmental goals for recovery of denials/underpayments. Reports denial/underpayment specifics and identifies trends. Improves methods for tracking, monitoring and appealing claim denials/underpayments.
    • Reviews monthly denials with leadership team of the physician's office, ancillary departments and revenue cycle. Identifies improvement opportunities, educational needs and reduction of denials opportunities.
    • Escalates payer denial trends or underpayments to appropriate internal leadership for quick resolution.
    • Gathers and reviews documentation via Medical Record and other peripheral documentation from outside physicians and clinicians. Writes formal Reconsideration and Appeal Letters based on circumstances surrounding the denial and/or the patient’s clinical indications. Complies and submits required documentation for appeal. Follows up with payer provider representative for contract issues and claim disputes. Facilitates peer-to-peer reviews. Ensures appeals are completed and filed per payer time limits. Documents all actions taken in appropriate computer systems.

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