Revenue Cycle Denials Specialist

Summary:

As a Revenue Cycle Denials Specialist you are responsible for identifying, investigating, appealing, and 

resolving denied or underpaid healthcare claims to maximize reimbursement and minimize 

revenue leakage. The role works closely with payers, providers, coding teams, clinical staff, and 

billing departments to ensure timely resolution of denied claims while maintaining compliance with 

payer and regulatory requirements.

Key Responsibilities:

• Review and analyze denied, rejected, and underpaid claims to determine root causes.

• Research payer policies, contracts, and reimbursement guidelines to support appeals and 

claim resolution.

• Prioritize denial inventory based on financial impact and timely filing requirements.

• Identify trends and recurring denial patterns and recommend corrective actions.

• Prepare and submit high-quality first-level, second-level, and administrative appeals. 

• Draft appeal letters supported by clinical documentation, coding guidelines, and payer 

policies. 

• Follow up with insurance carriers to ensure timely review and adjudication of appealed 

claims

• Maximize reimbursement through effective claim correction, reconsideration requests, 

and appeals. 

• Monitor aging denial accounts and ensure timely resolution. 

• Track recovered revenue and maintain performance metrics.

Qualifications

• College grad. or equivalent (Bachelor’s degree preferred)

• Minimum 2 years of experience in healthcare revenue cycle management, medical billing, 

collections, or denial management.

• Understanding of ICD-10-CM, CPT, HCPCS, and medical necessity guidelines.

• Experience with electronic health records (EHR) and billing systems.

• Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or 

similar certification is a plus.

• Experience in hospital, physician practice, or healthcare outsourcing/BPO environments is 

preferred.

• Clinical appeal writing experience preferred.

• Familiarity with payer portals and denial management software.

• Proficiency in Microsoft Excel, Word, and revenue cycle applications. 

• Knowledge of healthcare reimbursement methodologies.