Denials Jobs (NOW HIRING)

Job Purpose: Join Denova Collaborative Health as a Senior Denials Representative, where your expertise in denial management and revenue cycle operations helps recover revenue, reduce preventable denials, and improve financial performance. In this advanced role, you will manage complex appeals, resolve challenging payer issues, develop appeal strategies, and serve as a trusted resource for the denial management team. Your work will directly support Denova's mission of delivering integrated, whole-person healthcare while driving operational excellence and maximizing reimbursement.

This position is non-exempt and will report to the RCM System & Solution Mgr

What You Will Do:

Complex Appeals & Revenue Recovery

• Manage second-level appeals, payer project submissions, and complex clinical or contractual denials.
• Develop comprehensive appeal packages requiring medical records, contract interpretation, and regulatory documentation.
• Pursue escalated denials through resolution, including peer-to-peer reviews and external review processes when appropriate.
• Ensure all appeals and corrected claims are submitted within payer filing deadlines

Payer Relationships & Project Management

• Serve as the primary contact for assigned payer denial projects and monitor progress through resolution.
• Coordinate escalations directly with payer representatives and provider relations teams.
• Track payer-specific trends and identify opportunities to improve reimbursement outcomes.

Appeal Strategy & Knowledge Management

• Draft and enhance appeal language for new, uncommon, and payer-specific denial scenarios.
• Maintain and expand the organization's appeal template library to improve consistency and success rates.
• Identify recurring denial patterns and recommend process improvements to reduce future denials.

Team Support & Collaboration

• Serve as a subject matter expert for Denials Representatives by providing guidance on complex appeals, payer requirements, and denial resolution strategies.
• Support onboarding and mentor newer team members through informal coaching and knowledge sharing.
• Collaborate with leadership and cross-functional departments to improve denial prevention and revenue recovery initiatives.

Additional Responsibilities

• Meet advanced productivity and quality standards while managing complex denial work.
• Participate in and help lead process improvement initiatives.
• Perform other related duties as assigned.

What We Need From You:

Education

• High School Diploma or GED required.
• Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
• HFMA CRCR certification or other relevant healthcare revenue cycle certification is a plus.

Experience

• Three or more years of healthcare revenue cycle, denial management, medical billing, or insurance appeals experience with demonstrated accuracy and strong performance.
• Experience with Electronic Health Records (EHR) and practice management systems, preferably AMD.

Skills & Knowledge

• Advanced knowledge of medical billing, insurance appeals, payer regulations, reimbursement methodologies, and denial management.
• Strong understanding of CPT, HCPCS, ICD-10 coding, and medical necessity documentation.
• Excellent analytical and problem-solving skills with the ability to resolve complex payer issues.
• Strong written communication skills with experience preparing professional appeal letters and supporting documentation.
• Ability to mentor team members while independently managing complex assignments.
• Commitment to maintaining HIPAA compliance and protecting patient information.
• Must be located in Arizona

What Success Looks Like:

Our Senior Denials Representatives lead by example through accuracy, collaboration, and revenue recovery. Success in this role includes:

• Managing 35-45 complex denials per day while maintaining exceptional quality.
• Achieving a 60% or higher overturn rate on appealed denials.
• Submitting appeals within five business days of assignment.
• Developing new appeal templates and payer-specific language that improve future outcomes.
• Supporting the growth and success of the denial management team through mentorship and continuous process improvement

Your Work Schedule:

• Monday to Friday, 8 AM - 4:30 PM (Flexible)
• Location: Denova Collaborative Health LLC - DHQ (Hybrid Work Model after 90 days)

Perks of Being Part of Denova:

• Comprehensive low-cost medical, dental, and vision insurance.
• Generous retirement plan with a 3.5% company match.
• Secure your future with both long and short-term disability options
• Enjoy holiday pay, PTO, and life insurance benefits.
• We offer an employee wellness program and fantastic discounts for all Denova team members.
• And there's so much more waiting for you!

Our Revenue Cycle Mission Our Revenue Cycle team removes friction from the financial side of healthcare so our clinicians can focus on care and our patients can focus on healing.

We succeed when claims go out clean the first time, payments are posted quickly and accurately, denials are prevented, patients understand their responsibility, and team members feel supported. At Denova, we believe: people first, process second, technology third.

Denova Collaborative Health LLC is an integrated primary care and behavioral health practice based in the Greater Phoenix metropolitan area. Our comprehensive virtual care services are available for residents throughout the entire state of Arizona.

We provide a "whole person" approach to health and promote collaboration among our team of primary care providers and specialists. Our unique service integration of primary care, behavioral health, addiction medicine, and wellness enables our team to provide better health outcomes.