Clinical Denial Specialist

Job Summary

A company is looking for a Clinical Denial Specialist.

Key Responsibilities

• Receive, triage, and prioritize denied hospital claims based on various factors
• Conduct root cause analysis to identify reasons for denial and coordinate with relevant teams
• Assemble and submit appeal packets, ensuring compliance with clinical documentation and payer requirements

Required Qualifications

• Associate or bachelor's degree in healthcare administration, medical assistant, health information management, or a related field
• Prior experience in hospital revenue cycle, clinical denials, appeals, or medical claims processing
• Strong understanding of payer denial codes and hospital billing processes