Revenue Specialist, Denials
Core
Resolve outstanding denied healthcare claims through audits, appeals, and payer follow-ups to ensure accurate reimbursement for hospitals and surgery centers.
Role type
Senior IC revenue cycle specialist (denials management)
Builds
Clean accounts receivable and accelerated cash flow for healthcare clients
Domain
Healthcare revenue cycle management / Insurance claims processing
Deliverable
client delivery
Required skills
Healthcare billing and collections, Insurance claims processing, Medical coding (ICD, HCPCS/CPT), Revenue cycle process knowledge, Contract review and underpayment analysis, Medical terminology, Office applications (MS Office), Data privacy and security compliance
Preferred skills
Associate or Bachelor's degree, Client-facing/customer service experience
Technologies
EnableComp E360 RCM platform, MS Office, UB04, HCFA 1500 forms
Responsibilities
Review and evaluate denied claims using proprietary software to determine correct reimbursement, Research and acquire medical records to support claim appeals, Conduct telephone follow-ups with payers to ensure receipt of documentation and facilitate reimbursement, Identify complex underpayments by reviewing client/payer contracts
Seniority
Mid-level, hands-on IC