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Denial & Collections Specialist – Medical Billing (Clinic & Hospital Claims)

Job Overview
Busy medical practice is seeking an experienced Denial & Collections Specialist to join our revenue cycle team. This position is responsible for reviewing, correcting, and resolving insurance claim denials for both clinic and hospital-based services, as well as following up on outstanding balances to ensure accurate and timely reimbursement.

The ideal candidate is detail-oriented, knowledgeable in medical billing processes, and experienced in working with multiple insurance payers.

Key Responsibilities

Review and analyze insurance claim denials and rejections
Correct and resubmit denied or underpaid claims
Perform insurance follow-up on outstanding claims
Work denials for commercial insurance, Medicare, and Medicaid
Identify root causes of denials and recommend solutions to prevent future issues
Post adjustments and maintain accurate documentation in billing system
Communicate with insurance companies regarding claim status and appeals
Prepare and submit appeals with supporting documentation
Monitor aging reports and prioritize high-dollar claims
Collaborate with providers and billing team to resolve coding or documentation issues

Qualifications

Minimum 2 years experience in medical billing, denial management, or insurance collections
Experience with clinic and hospital claims preferred
Knowledge of CPT, ICD-10, and insurance billing guidelines
Familiar with Medicare, Medicaid, and commercial payers
Strong attention to detail and organizational skills
Ability to work independently and manage claim follow-up efficiently
Experience with electronic medical records and billing systems

Preferred Skills