Position Summary
The Denial Management Specialist is responsible for reviewing, analyzing, and resolving payer denials. The role focuses on root-cause identification, appeal submission, and prevention strategies to improve first-pass acceptance and revenue recovery.
Key Responsibilities
Denial Review & Resolution
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Analyze denial codes, EOBs, and payer correspondence.
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Determine corrective actions: corrected claim, appeal, or documentation request.
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Prepare appeal packets including clinical notes, letters, and supporting evidence.
Root-Cause Analysis
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Categorize denials (coding, eligibility, authorization, bundling, documentation).
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Identify trends and escalate repeat issues to team leadership.
Tracking & Reporting
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Maintain denial logs with actions, outcomes, and recovery amounts.
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Provide weekly denial summary reports and recommendations.
Cross-Functional Collaboration
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Work with coders, billers, and charge entry to correct workflows.
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Provide education on recurring denial patterns.
Qualifications
Required
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2+ years in denial management or AR follow-up.
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Knowledge of payer policies, appeal timelines, and CARC/RARC codes.
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Strong analytical and written communication skills.
Preferred
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Experience with specialty care denials (especially retina).
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Familiarity with payer portals and electronic appeals.
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Familiarity with PM/EHR systems (e.g., Healthpac, NextTech, ModMed, ECW, Athena, MedInformatics, AdvancedMD).
Core Competencies
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Analytical problem-solving
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Written communication
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Documentation review
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Persistence and follow-through
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Organization
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Attention to detail
Work Environment
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Remote or hybrid based on company structure.
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May require occasional payer calls or joint review meetings.
