Denial Management Specialist

Denial Management Specialist Apply Overview Salary Range $18.00 - $25.00 Hourly Level Experienced Position Type Full Time Apply Description Position Summary The Denial Management Specialist is responsible for reviewing, analyzing, and resolving payer denials. The role focuses on root-cause identification, appeal submission, and prevention strategies to improve first-pass acceptance and revenue recovery. Key Responsibilities Denial Review & Resolution Analyze denial codes, EOBs, and payer correspondence. Determine corrective actions: corrected claim, appeal, or documentation request. Prepare appeal packets including clinical notes, letters, and supporting evidence. Root-Cause Analysis Categorize denials (coding, eligibility, authorization, bundling, documentation). Identify trends and escalate repeat issues to team leadership. Tracking & Reporting Maintain denial logs with actions, outcomes, and recovery amounts. Provide weekly denial summary reports and recommendations. Cross-Functional Collaboration Work with coders, billers, and charge entry to correct workflows. Provide education on recurring denial patterns. Qualifications Required 2+ years in denial management or AR follow-up. Knowledge of payer policies, appeal timelines, and CARC/RARC codes. Strong analytical and written communication skills. Preferred Experience with specialty care denials (especially retina). Familiarity with payer portals and electronic appeals. Familiarity with PM/EHR systems (e.g., Healthpac, NextTech, ModMed, ECW, Athena, MedInformatics, AdvancedMD). Core Competencies Analytical problem-solving Written communication Documentation review Persistence and follow-through Organization Attention to detail Work Environment Remote or hybrid based on company structure.