Denials Specialist

Job Description

Position Summary

The Denials Specialist is responsible for analyzing, appealing, and resolving denied or underpaid insurance claims. This role requires a detailed understanding of payer policies, strong follow-up skills, and collaboration across billing, coding, and clinical teams to reduce denial rates, secure reimbursement, and improve cash flow.

Key Responsibilities

Denial Analysis & Resolution

• Review and categorize denied claims by payer, denial reason, and service type.
• Investigate root causes of denials and identify trends.
• Correct errors and resubmit claims in a timely manner.
• Draft and submit clear, evidence-based appeals to payers.

Payer Follow-Up

Collaboration & Documentation

Performance Monitoring

Qualifications