Pfs Representative Iii - Denials Specialist Job at Tucson Medical Center (Tucson)

Pfs Representative Iii - Denials Specialist

Tucson Medical Center

Location:
United States , Tucson

Category:
Finance

Contract Type:
Not provided

Salary:

Not provided

Save Job

Apply Position

Job Description:

May perform the following based on job role as defined under essential functions. Performs Medicare billing and follow up, commercial and state Medicaid appeals, preparation for state Medicaid state fair hearings. Prepares refunds for payers and patient accounts which includes a complex review and reconciliation of government and non-government payers. Resolves problematic accounts demonstrating complete understanding of payer contracts and or payer requirements to ensure timely and accurate payments or timely responses on credits, recoupments, and refund requests. May be responsible for balancing all cash receipts and daily/monthly workbook with the finance department. (job specific). Makes independent decisions based on payer guidelines for reconciling, billing and or credit balances on accounts.

Job Responsibility:

Assists management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows
Ensures UB04 and HCFA 1500 claims and/or self-pay patient accounts are billed in a timely, complete, and accurate manner in accordance with appropriate guidelines
Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence
Demonstrates understanding of the entire revenue cycle
Provides routine daily internal and external interface with unit/department management and staff, other service areas, information systems, physicians, physicians’ office staff, patients, software/hardware vendors, and third-party payers in order to resolve patient concerns, disputes, and billing audits in order to receive payment
Assists with problem solving, inquiries, and customer interaction to ensure positive results
Researches and analyzes any correspondence received related to assigned accounts
Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication
Analyzes patient accounts, determines non-collectable accounts, and recommends bad debt or charity write-offs when applicable
analyzes and processes contractual write offs
Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards
Ensures patient accounts are refunded and/or billed in a timely, complete, and accurate manner in accordance with payer contracts and payer guidelines, and/or billing and follow-up guidelines
Prepares and enters contractual write-offs and dispute letters to Medicare or insurance carriers as required
Serves as information resource to patients and hospital staff regarding credit and collection policies or Medicare polices and benefits
Analyzes and prepares commercial/Medicaid payer claim denial reconsiderations and or formal disputes as needed on non-clinical denials based on payer guidelines
Follows up on all appealed claims assigned, escalating as needed based on appeal levels with the payer
Maintains online payer resource reference library related to payer policies utilized for follow up and or appeals
Reviews/analyzes payer driven denial reason codes to determine root cause of the denial
Submits recommendations to Management on any identified trends in order to assist in reducing denials
Trains and assists in the implementation of new software programs/systems and related technologies
Performs related duties as assigned
Performs complex reviews and reconciliation of non-clinical denied commercial and Medicaid claims
Communicates with insurance companies and issues related to claim denials
Files corrected claims or levels of appeals as appropriate
Works independently to resolve problems and demonstrates complete understanding of payer requirements related to disputes/appeals on denied claims
Will assist in developing and maintaining standardized processes related to individual payer requirements
Assists in identifying denial root causes and communicates resolution to Management to correct any denial trends

Requirements:

High School diploma or General Education Degree (GED)
Three (3) years of related experience, specific to role specialty such as medical billing or third-party collection, or customer service in a hospital, payer, or physician setting
Technical experience in CMS/Medicaid regulations and/or commercial payer billing requirements
Minimum three (3) years’ experience in a windows environment, including Excel
Relevant professional certification encouraged within 2 years
Knowledge of medical insurance practices and policies and regulations
Knowledge of HMO, PPO, and Indemnity third party billing guidelines
Knowledge of either UB04 hospital or CMS physician billing forms
Knowledge of government and non-government uniform billing guidelines
Knowledge of medical terminology and coding Related to hospital billing and/or professional billing such as revenue, CPT diagnosis codes, modifiers, occurrence codes, value codes, and the appropriate usage of these codes
Skill in evaluating bills/claims for payers or patients in order to collect payment in a timely manner
Skill in providing assistance or training to other staff members in a team environment
Skill in the use of computer applications and systems including: Excel, Word, Internet, email, and miscellaneous programs and networked computer systems
Ability to read and comprehend instructions, short correspondence, and memos
Ability to write correspondence
ability to effectively present information in one-on-one and small groups situations to customers, clients, and other employees of the organization
Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations
Ability to effectively present information and respond to inquiries or complaints from payers, patients and/or their representatives
Ability to demonstrate familiarity of the components of a medical chart in order to supply appropriate chart documentation to various payers as required
Ability to identify any trends related to their assigned payer in order to escalate to management or provider representative
Ability to read and interpret payer explanations of benefit documents
Strong analytical and critical thinking abilities in order to make sound decisions
Ability to demonstrate compliance with all state and federal regulations for managed care and third-party payers
Ability to handle higher complexity accounts
Self-starter with ability to research independently

Additional Information:

Job Posted:
February 16, 2026

Employment Type:

Fulltime

Work Type:

On-site work

Tucson Medical Center - All Job Offers

Job Link Share:

Pfs Representative Iii - Denials Specialist

Tucson Medical Center

Location:
United States , Tucson

Category:
Finance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
February 16, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Pfs Representative Iii - Denials Specialist

Change Manager

Executive Head Chef

Senior Client Success Manager

Remote Board Certified Behavior Analyst

Lecturer (Professional Practice)

Senior Compensation & Benefits Manager

Sales Representative

Lead Commercial Banking Relationship Manager

Pfs Representative Iii - Denials Specialist

Tucson Medical Center

Location:United States , Tucson

Category:Finance

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:February 16, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Pfs Representative Iii - Denials Specialist

Change Manager

Executive Head Chef

Senior Client Success Manager

Remote Board Certified Behavior Analyst

Lecturer (Professional Practice)

Senior Compensation & Benefits Manager

Sales Representative

Lead Commercial Banking Relationship Manager

Location:
United States , Tucson

Category:
Finance

Contract Type:
Not provided

Job Posted:
February 16, 2026