Denial and Appeal Specialist

Job Summary

Owning denial management end-to-end, the full-time remote Denial and Appeal Specialist will manage denial buckets across multiple payer relationships, write and submit appeals, and analyze remittance files to drive measurable improvement in denial rates.

Key responsibilities

• Manage and resolve denial buckets across various payer relationships, focusing on pattern-level resolution
• Write and submit clinical and administrative appeals, escalating to peer-to-peer review as necessary
• Analyze 835 remittance files to identify denial reason codes and trace root causes back to submission or coding errors

Required qualifications

• 3+ years of medical billing experience with a focus on denials and appeals
• Hands-on experience with Medicaid managed care and Medicare Advantage payers
• Proficiency in reading and interpreting 835 remittance files and CARC/RARC codes
• Experience with CMS-1500 and/or UB-04 billing
• Strong written communication skills for composing appeals