Medical Denials Specialist

We are looking for a detail-oriented Medical Denials Specialist to support revenue cycle performance for a healthcare organization. This Contract position focuses on resolving complex claim issues, improving reimbursement outcomes, and maintaining strong follow-up across payer accounts within the outpatient and behavioral health space. The ideal candidate will bring experience in medical billing and accounts receivable work, with the ability to investigate denials, coordinate corrections, and keep account documentation current and accurate.

Responsibilities:

• Investigate unpaid, partially paid, denied, or rejected medical claims and take appropriate steps to secure accurate reimbursement from insurance carriers.

• Determine the underlying cause of claim issues and complete the necessary actions, including corrected submissions, formal appeals, account updates, and requests for supporting records.

• Draft and send well-supported appeal correspondence in accordance with payer deadlines, documentation standards, and reimbursement policies.

• Manage open accounts receivable by reviewing aging reports, prioritizing follow-up activity, and working toward established resolution goals.

• Communicate with payers to verify claim status, clarify payment decisions, and elevate unresolved matters when additional review is required.

• Examine differences between charges billed and payer processing results to identify payment variances and recover outstanding balances.

• Partner with billing, coding, and clinical teams to address claim edits, authorization concerns, and denial issues tied to documentation or coding accuracy.

• Prepare reporting on denial activity, payer behavior, and receivables performance to help identify improvement opportunities within the revenue cycle process.

Qualifications:

• Experience in medical accounts receivable, insurance follow-up, or healthcare billing within an outpatient or behavioral health environment.

• Experience working with Substance Use Disorder (SUD) denials and payers.

• Working knowledge of denial management, claims resolution, appeals processing, and payer follow-up procedures.

• Familiarity with medical billing practices, accounts receivable workflows, cash activity, and commercial collections processes.

• Ability to research adjudication outcomes, identify claim discrepancies, and resolve underpayments or denied balances accurately.

• Proficiency in using electronic medical record or billing systems to review account activity, document follow-up, and track claim status.

• Understanding of payer guidelines and applicable state and federal billing requirements in a regulated healthcare setting.

• Strong written and verbal communication skills with the ability to collaborate across billing, coding, and clinical teams.

Compensation

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