Revenue Cycle Denial Specialist

Role Description

This position can be remote. Please review the approved remote states below.

• Arizona
• Florida
• Georgia
• Idaho
• Iowa
• South Dakota
• Texas
• South Carolina
• Wisconsin
• North Carolina
• Michigan

*If your state is not listed, you must relocate to Montana or one of the approved states above to be eligible for this position.

The Revenue Cycle Denial Specialist reviews, analyzes, and resolves post-billed denials and rejections for hospital and professional claims to support accurate reimbursement and denial prevention. This role applies expertise in payer requirements, government regulations, and appeal processes to determine root cause, validate denial rationale, and drive corrective actions. The specialist prepares and manages appeals within required timelines, collaborates across departments to reduce avoidable denials, and provides reporting and education to support system-wide revenue cycle performance. Provides reporting, analysis, and coordination support for the Denial Steering Committee and Task Force to drive denial reduction strategies and operational improvements.

Qualifications

• Associate's degree or Certification in Healthcare Business, or related field, or equivalent combination of education and experience may be considered.
• Three (3) years of healthcare experience in a revenue cycle position.
• Three (3) years of experience working with International Classification of Diseases, Tenth Revision (ICD-10) diagnosis and procedure coding, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), modifiers, and coding guidelines.
• Proficiency with Microsoft Office applications, including advanced Excel, Word, and PowerPoint skills.

Requirements

• Healthcare Financial Management Association Revendure Cycle Representative (HFMA CRCR) or Certified Professional Coder (CPC) certifications (Preferred).
• Five (5) years of experience in a hospital revenue cycle billing position (Preferred).
• Experience with Epic or other electronic medical record (EMR) applications (Preferred).
• Experience using payer portals, electronic work queues, and denial/appeals tracking tools (Preferred).

Essential Job Functions

• Analyze denials to determine root cause, appeal eligibility, and appropriate resolution strategy.
• Prepare, submit, and track payer appeals and reconsiderations within required timeframes.
• Manage the full appeal lifecycle, ensuring compliance with contractual and regulatory requirements.
• Monitor denial and appeal trends; develop reports and dashboards for leadership and committees.
• Present findings and recommendations to support denial reduction and process improvement efforts.
• Collaborate with coding, billing, clinical, compliance, and operational teams to address denial drivers.
• Develop and deliver education and training to reduce avoidable denials and improve workflows.
• Support denial-related committees and task forces through reporting, analysis, and coordination.
• Manage audit requests, including Recovery Audit Contractor (RAC) and governmental audits, ensuring timely submission and tracking.
• Perform audits and utilize reporting tools (e.g., Epic) to support data analysis and operational insights.
• Maintain knowledge of payer rules, state and federal regulations, and reimbursement requirements.

Knowledge, Skills and Abilities

• Demonstrates sound judgment, patience, and maintains a professional demeanor at all times.
• Exercises tact, discretion, sensitivity, and maintains confidentiality.
• Performs essential job functions successfully in a busy and stressful environment.
• Learns current and new computer applications and office equipment utilized at Bozeman Health.
• Strong interpersonal, verbal, and written communication skills.
• Analyzes, organizes, and prioritizes work while meeting multiple deadlines.

Schedule Requirements

• This role requires regular and sustained attendance.
• The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts.
• On-call work may be required to respond promptly to organizational, patient, or employee needs.

Physical Requirements

• Lifting (Rarely – 30 pounds): Exerting force occasionally and/or using a negligible amount of force to lift, carry, push, pull, or otherwise move objects or people.
• Sit (Continuously): Maintaining a sitting posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Stand (Occasionally): Maintaining a standing posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Walk (Occasionally): Walking and moving around within the work area requires good balance and coordination.
• Climb (Rarely): Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like using feet and legs; may also use hands and arms.
• Twist/Bend/Stoop/Kneel (Occasionally): Twisting, bending, stooping, and kneeling require flexibility and a wide range of motion in the spine and joints.
• Reach Above Shoulder Level (Occasionally): Lifting, carrying, pushing, or pulling objects as necessary above the shoulder, requiring strength and stability.
• Push/Pull (Occasionally): Using the upper extremities to press or exert force against something with steady force to thrust forward, downward, or outward.
• Fine-Finger Movements (Continuously): Picking, pinching, typing, or otherwise working primarily with fingers rather than using the whole hand as in handling.
• Vision (Continuously): Close visual acuity to prepare and analyze data and figures and to read computer screens, printed materials, and handwritten materials.
• Cognitive Skills (Continuously): Learn new tasks, remember processes, maintain focus, complete tasks independently, and make timely decisions in the context of a workflow.
• Exposures (Rarely): Bloodborne pathogens, such as blood, bodily fluids, or tissues. Radiation in settings where medical imaging procedures are performed. Various chemicals and medications are used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances. Infectious diseases due to contact with patients in areas that may have contagious illnesses.