Billing & Claims Denial Specialist

Job Summary
We are seeking a detail-oriented and proactive Billing & Claims Denial Specialist to join our healthcare billing team. This role is responsible for managing, reviewing, and resolving insurance claim denials to ensure accurate and timely reimbursement. This role involves in-depth analysis of claim rejections, communication with insurance payers, and collaboration with internal departments to correct billing errors, submit appeals, and reduce the overall denial rate. The ideal candidate is detail-oriented, analytical, and experienced in medical billing practices and insurance guidelines.

Primary Duties & Responsibilities

The duties and responsibilities listed herein represent the Essential Functions this position regularly and customarily performs. As such, this list is not intended to be exhaustive, and additional job-related duties that are similar in nature or logical extensions of the Essential Functions may also be performed.

The primary responsibility of the Billing & Claims Specialist is claims review and resolution.

1. Reviews insurance denials and explanations of benefits (EOBs) to determine root causes and identify required corrective actions.

2. Corrects claim errors, updates coding or documentation when needed, and resubmits claims within 30 days of claim denial.

3. Prepares and submits appeal letters with supporting documentation for denied or underpaid claims.

4. Tracks and follows up on outstanding appeals or reconsiderations until final resolution.

5. Analyzes denial trends and works proactively to reduce recurring issues.

6. Maintains detailed, accurate documentation of claim statuses, actions taken, and communications.

7. Generates denial reports for leadership and participates in improvement initiatives.

8. Communicates with insurance payers to clarify denial reasons, coverage policies, and required documentation.

9. Works toward achieving an average reversible denial rate of 85–96%, with ongoing review of performance trends to support continuous improvement.

10. Works closely with billing staff, coders, clinical teams, and management to resolve discrepancies and prevent future denials.

11. Provides feedback and training to internal teams on billing errors, documentation needs, or payer-specific guidelines.

12. Actively pursues ongoing education to stay current with medical billing regulations, payer requirements, coding updates, and compliance standards to ensure accurate and timely claims processing.

13. Serves as a backup to other billing specialists and assists with answering phones as needed to support department operations.

Qualifications & Education Requirements

1. High school diploma or equivalent.

2. Minimum of one year of relevant experience in medical billing, claims denial management, or healthcare revenue cycle.

3. Strong understanding of insurance claims processing, EOBs, coding basics (ICD‑10, CPT, HCPCS), and payer guidelines.

4. Excellent analytical, problem‑solving, and organizational skills.

5. Proficiency with billing software, clearinghouses, and Microsoft Office tools.

6. Strong self‑management skills, including the ability to plan, organize, and follow through on work assignments.

7. Fluent English/Spanish language skills desired

8. Prior Billing and Denial experience preferred.

Position Also Requires:

· Prolonged periods sitting at a desk and working on a computer

· Use of a phone headset or handset

· Must be able to lift up to 15 pounds at times

· Typical setting is an office with moderate office noise level

· Regular and reliable on-site attendance

Pay: $17.00 - $23.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Experience:

• medical billing: 1 year (Required)

Work Location: In person