Denials & Appeals Specialist
RemoteUnited States
United StatesRemoteFull TimeStartup
Full TimeStartup
Job Summary
Review denied claims to identify specific denial reasons, then research payer policies and documentation to determine appropriate resolutions. Correct claim errors and resubmit claims when necessary, while preparing and submitting reconsiderations and appeals with accurate supporting materials. Follow up with payers on outstanding appeals, document all actions and responses, and monitor denial trends to identify recurring issues affecting reimbursement. Collaborate with billing and coding teams to address root causes of denials and maintain accurate records of resolution outcomes.
Required Qualifications
- 2+ years of experience in healthcare denials, appeals, medical billing, or a related revenue cycle role
- Strong understanding of common claim denial reasons and payer requirements
- Experience researching denied claims and determining appropriate corrective action
- Experience preparing and submitting insurance claim appeals or reconsiderations
- Ability to interpret EOBs, ERAs, denial codes, and payer correspondence
- Strong attention to detail and ability to manage multiple claims and deadlines
- Excellent written communication skills for preparing clear and well-supported appeals
- Strong problem-solving skills and ability to work independently in a remote environment
- HIPAA-compliant private workspace
Desired Qualifications
- Experience with Epic, Athena, eClinicalWorks, or another major billing or practice management system
- Medical coding knowledge or certification
- Experience with specific payer types or specialty-specific denials
- Experience analyzing denial trends and root causes
- Experience working with provider groups or hospitals
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.