Clinical Denial Specialist

Clinical Denial Specialist receives, triages, and prioritizes denied hospital claims, conducts root cause analysis, and coordinates clinical denial cases with nurse reviewers and revenue cycle teams. Performs systematic appeal follow-up and tracks denial and appeal activity. Identifies denial trends and communicates findings to leadership to support process improvement initiatives.

Requirements

• Associate or bachelor’s degree in healthcare administration, medical assistant, health information management, or a related field.
• Prior experience in hospital revenue cycle, clinical denials, appeals, utilization management, or medical claims processing.
• Strong understanding of payer denial codes, appeal workflows, and hospital billing processes.

Benefits

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program