Denial Management Specialist

Position Summary
The Denial Management Specialist is responsible for reviewing and resolving rejection and denial work queues to ensure Mercy receives appropriate reimbursement for services rendered. This role requires a strong understanding of insurance plans, prior authorization requirements, and revenue cycle workflows. The ideal candidate is detail‑oriented, organized, and comfortable collaborating with internal teams and external insurance partners.

Key Responsibilities

• Review and manage rejection and denial work queues to ensure timely and accurate resolution
• Identify root causes of denials and take appropriate action to facilitate reimbursement
• Work closely with patients, physicians, clinical and non‑clinical staff, and insurance companies
• Utilize computer systems and work queues to track, document, and resolve assigned accounts
• Communicate clearly and professionally via phone and written correspondence
• Meet deadlines and maintain accuracy while managing workload in a fast‑paced environment

Minimum Required Qualifications

Education

• High School Diploma or equivalent

Licensure / Certification

• None required

Experience

• Previous experience in a healthcare or insurance‑related setting preferred

Skills & Knowledge

• Excellent verbal and written communication skills; strong telephone etiquette required
• Ability to establish and maintain effective working relationships with patients, physicians, hospital staff, and insurance companies
• Strong interpersonal and customer service skills
• Strong organizational skills with high attention to detail
• Ability to work under stress, meet deadlines, and perform daily assignments with consistent accuracy
• Proficiency with computer systems and ability to learn new applications quickly

Preferred Qualifications

Experience

• Experience with medical terminology
• Familiarity with insurance plans, prior authorizations, denial management, and work queues

Education / Licensure / Certification

• Not required, but related healthcare or revenue cycle education and training is a plus