Denials Appeal Representative

SUMMARY

Under the general supervision of the Director of Finance, the Denials Appeal Representative is responsible for the review, analysis, and resolution of Gateway denials within the Brown Health Power BI database. This position conducts monthly denial trending, partners with revenue cycle staff to appeal denied claims, and identifies patterns contributing to recurring denials. The Denials Appeal Representative prepares monthly denial reports for the Director of Finance and collaborates with EPIC billing and operational teams to determine whether system build adjustments or staff retraining are required to reduce preventable denials. The role requires strong analytical skills, effective communication, and the ability to work collaboratively across operational and clinical departments.

PRINCIPAL DUTIES AND RESPONSIBILITIES

Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these guide our everyday actions with patients, customers, and one another.

• Consistently applies the corporate values of respect, honesty, and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible, and high-value services within the environment of a comprehensive integrated academic health system.
• Is responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct.
• Review federal and state documentation for changes in billing regulations.
• Perform posting and/or reconciliation of numerical data or departmental and/or hospital accounting records.
• Review patient accounting records and documents to verify accuracy of charges and third-party information and initiate corrections.
• Performs insurance billing duties/view claims in the system, including review and verification of patient account information against insurance program specifications.
• Effective interpersonal and communication skills required.
• Self-driven, results-oriented with a positive outlook.
• Ability to develop and maintain effective working relationships with staff.
• Act as liaison and attend meetings with both internal and external departments when necessary to perform duties and aid in organization development.
• Maintain productivity measures and accuracy standards defined by the department.
• Contact other departments or personnel as necessary to resolve errors and omissions.
• Utilize a variety of systems necessary to resolve problems.
• Participate in educational programs and in-service meetings.
• May participate in training of new employees.
• Maintain quality assurance, safety, environmental, and infection control in accordance with established policies, procedures, and objectives.
• Perform other related duties as required.

BASIC KNOWLEDGE

High School diploma with proficiency in MS Office (Excel and Word).

EXPERIENCE

One–two years’ experience in health care/patient accounting or relevant setting; or equivalent combination of training and relevant work experience.

SUPERVISORY RESPONSIBILITY

None.

Pay Range

$20.96-$34.61

Location

Gateway Healthcare Inc. - 101 Bacon Street Pawtucket, Rhode Island 02860

Work Type

M-F 8:00am-4:30pm

Work Shift

Day

Daily Hours

8 hours

Driving Required

No

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.