Full-Time Denials Specialist

Denials Specialist

At Ashe Memorial Hospital, we are driven by our mission: "To meet the needs of the community by delivering patient-centered, high quality health care."

Ashe Memorial Hospital is proud to have been voted Ashe's Best Place to Work in 2022, 2023, 2024, and 2025. Join a team recognized throughout the community for excellence in healthcare, including awards for Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice. This is your opportunity to make a meaningful difference in a close-knit mountain community.

Position Details

• Position: Denials Specialist
• Department: Patient Accounting
• Schedule: Full-Time | 1st Shift | MondayFriday
• Location: On-site at Ashe Memorial Hospital in Jefferson, NC
• Remote Work: This is not a remote or hybrid position
• Supervisory Responsibilities: None
• Travel Requirements: None
• Compensation: Pay commensurate with experience

Position Summary

The Denials Specialist is responsible for researching, analyzing, resolving, and trending denials and rejections throughout the revenue cycle process. This position plays a critical role in ensuring accurate claim adjudication, maximizing reimbursement, and supporting overall revenue cycle integrity.

The ideal candidate will possess strong analytical and problem-solving skills with the ability to identify root causes of denials, coordinate appeals, and collaborate across departments to improve workflows and reduce future denials. This role requires a detailed understanding of payer requirements, reimbursement methodologies, and healthcare billing processes.

Minimum Qualifications

Education

• High School diploma or equivalent required
• Associate degree preferred
• Post-secondary coursework in insurance billing, data processing, or medical terminology preferred

Experience

• Minimum of three (3) years of experience in billing, accounts receivable follow-up, denials management, or appeal writing preferred
• One (1) year of experience in computerized third-party billing for facility and/or professional services required
• Knowledge of third-party billing requirements required
• Previous hospital and/or professional business office experience preferred
• Experience with Meditech and/or SSI systems preferred

Essential Functions

• Work complex denials across multiple payers and service areas
• Conduct detailed account research including patient encounters, payment histories, payer remittance advice, and claim status activity
• Investigate contract discrepancies and account balances to ensure timely and accurate claim adjudication
• Prepare, defend, and submit denied claim appeals including supporting documentation and follow-up activities
• Communicate denial root causes, trends, and resolutions to leadership as needed
• Compile and submit complete appeal packets through mail, fax, or secure electronic submission
• Review credit balances and coordinate payer refunds when appropriate
• Resolve assigned accounts through daily work queues and follow-up activities
• Track and trend denial and rejection patterns to identify process improvement opportunities
• Recommend workflow or contracting improvements to support reimbursement optimization and operational efficiency
• Maintain confidentiality and compliance with HIPAA and organizational policies
• Promote professionalism, teamwork, and positive patient experiences
• Perform additional duties as assigned

Required Skills & Competencies

• Proficiency with hospital information systems, payment review systems, and coding methodologies
• Strong analytical, quantitative, and organizational skills
• Advanced understanding of Explanation of Benefits (EOBs)
• Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards
• Understanding of CMS memos, transmittals, and reimbursement methodologies
• Familiarity with medical records, professional and institutional claims, and chargemaster processes
• Ability to identify coding discrepancies, clerical errors, and reimbursement issues
• Strong knowledge of insurance terminology, ancillary charges, and multi-specialty departmental workflows
• Ability to work independently and collaboratively in a fast-paced environment

Candidate Expectations

We are seeking a motivated and team-oriented professional who demonstrates collaboration, accountability, and positive representation of Ashe Memorial Hospital. The ideal candidate values professionalism, communication, and exceptional service while supporting the hospital's mission of delivering outstanding patient-centered care.

Additional Requirements

• Must be willing to receive all required vaccinations as a condition of employment unless an approved exemption has been granted
• Criminal background check and pre-employment drug screening required upon conditional offer of employment

Application Instructions

To apply, please complete an employment application and attach:

• Resume
• Cover Letter
• Employment history including explanations for gaps in employment and reasons for separation

Benefits become effective the first of the month following employment, in accordance with hospital policy.

For a full job description and complete benefits information, please contact Human Resources.

Equal Opportunity Employer

Ashe Memorial Hospital is an Equal Opportunity Employer and considers applicants based on qualifications, experience, and ability to perform the essential functions of the position. Reasonable accommodations may be made for qualified individuals with disabilities without compromising patient care. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, genetic information, or any other status protected by applicable law.