Company Overview
Our client is a healthcare services organization focused on optimizing revenue cycle performance for hospitals and provider networks. They partner with healthcare systems to navigate complex payer requirements, reduce denials, and improve reimbursement outcomes. With a strong emphasis on accuracy, compliance, and operational excellence, they foster a collaborative environment dedicated to continuous improvement and measurable financial impact.
Role Summary
The Denials Appeals Specialist is responsible for driving resolution of denied claims through detailed analysis, strategic appeal development, and consistent follow-up with payers. This role directly contributes to improving cash flow, reducing revenue leakage, and strengthening overall revenue cycle performance.
In this position, you will analyze denial root causes, prepare compelling appeal documentation, and work across multiple systems to ensure accurate and timely submissions. You will collaborate with internal stakeholders and external partners to resolve accounts, identify denial trends, and support initiatives that enhance reimbursement success and operational efficiency.
Key Responsibilities
• Review denied claims to determine root cause and define appropriate appeal strategy
• Prepare and submit detailed written and electronic appeals in alignment with payer guidelines
• Conduct follow-up with insurance carriers to track claim status and drive resolution
• Investigate insurance coverage, eligibility, and claim details across multiple service lines
• Document all claim activity, appeal submissions, and outcomes accurately in internal systems
• Identify and resolve billing discrepancies, contractual adjustments, and administrative errors
• Communicate effectively with payers, healthcare providers, and internal teams to resolve claims
• Analyze denial trends and contribute to process improvement initiatives
Key Requirements
• 1 to 4 years of experience in healthcare revenue cycle, denials, or appeals management
• High School Diploma or GED required, Bachelor’s degree preferred
• Strong understanding of insurance claims, payer guidelines, and denial management processes
• Experience working with EMR systems such as Epic and payer portals
• Proven ability to analyze denial root causes and develop effective appeal strategies
• Strong written communication skills with the ability to draft clear, persuasive appeals
• High attention to detail with strong organizational and time management skills
• Ability to work independently while collaborating effectively in a team environment
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