<p>This fully remote Denial Management Representative role is based out of Frisco, TX and sits within a large, nationally recognized healthcare revenue cycle organization serving clients across more than 135 local regions. The position focuses on end-to-end account resolution — from claim follow-up and remittance review through insurance appeals and collections — across Commercial, Managed Care, Medicare, and Medicaid payers. Candidates with 1–4 years of hospital or medical claims experience and a solid command of the revenue cycle will find a structured, team-oriented environment with genuine growth potential and a competitive hourly compensation range.</p>
<h3>Perks and Benefits</h3> <ul> <li>Hourly pay range: $15.80 – $23.70; actual rate depends on location, qualifications, and experience</li> <li>Signing bonus available for qualified new hires, subject to employment status</li> <li>401(k) retirement plan with up to 6% employer match</li> <li>Medical, dental, vision, disability, and life insurance</li> <li>Paid time off (vacation and sick leave) — minimum 12 days per year, accruing at approximately 1.84 hours per 40 hours worked</li> <li>10 paid holidays per year; observed holidays paid at time-and-a-half</li> <li>Health savings account (HSA); healthcare and dependent flexible spending accounts (FSA)</li> <li>Employee Assistance Program and employee discount program</li> <li>Voluntary benefits: pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder and childcare support, AD&D, auto and home insurance</li> <li>Colorado-based employees receive paid leave in accordance with Colorado's Healthy Families and Workplaces Act</li> </ul>
<h3>Practice Highlights</h3> <ul> <li>Fully remote position; work-from-home with standard computer terminal setup required</li> <li>Responsible for managing a personal desk inventory of accounts — following up on claim submissions, reviewing remittances, and pursuing disputed balances from both government and non-government payers</li> <li>Payer mix spans Commercial, Managed Care, Medicare, and Medicaid; familiarity with HMO, PPO, IPA, and Capitation payment structures is directly applicable</li> <li>Works within multiple proprietary patient accounting systems: ACE, VI Web, IMaCS, and OnDemand, as well as payer web portals</li> <li>Responsibilities include updating plan IDs, correcting demographic and insurance data, identifying billing and coding issues, requesting re-bills or corrected claims, and opening dispute records as needed</li> <li>Monitors payer trends and A/R aging; escalates payment delays and problem accounts to supervisory staff in a timely manner</li> <li>Collaborates with a broader revenue cycle team; provides coverage support for absent or backlogged colleagues</li> <li>Participates in ongoing training seminars, in-services, and team meetings to maintain and expand job knowledge</li> <li>Operates within a call-center-style team environment with defined daily productivity and quality standards set by leadership</li> <li>Ensures compliance with applicable state and federal laws and regulations governing Managed Care and third-party payers</li> </ul>
<h3>Qualifications</h3> <ul> <li>High school diploma or equivalent required; some college coursework in business administration or accounting preferred</li> <li>1–4 years of medical claims and/or hospital collections experience</li> <li>Thorough understanding of the full revenue cycle: patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections)</li> <li>Intermediate knowledge of Managed Care contracts, contract language, and federal and state requirements for government payers</li> <li>Working knowledge of hospital billing form requirements (UB-04) and familiarity with the HCFA-1500 form</li> <li>Intermediate proficiency with Explanation of Benefits (EOB) interpretation</li> <li>Intermediate skill in Microsoft Office (Word and Excel)</li> <li>Minimum typing speed of 45 words per minute</li> <li>Above-average analytical and critical thinking skills; ability to problem-solve, prioritize, and follow through independently with minimal supervision</li> <li>Vaccination requirements apply; candidates must provide confirmation of all required vaccinations and screenings prior to start of employment, which may include COVID-19, influenza, and any future required vaccines</li> </ul>
<h3>About the Community</h3> <p>This role is fully remote, making it accessible to candidates across the country regardless of proximity to Frisco, TX. Frisco itself is a rapidly growing suburb north of Dallas in the Dallas–Fort Worth Metroplex — one of the most economically dynamic regions in the country, offering a low state income tax environment, a strong job market, highly rated public schools, and a wide range of dining, entertainment, and outdoor recreation options. Candidates who prefer to be near the home office will find Frisco a family-friendly, amenity-rich community with easy access to the broader DFW metro.</p>