Appeal and Denial SpecialistCarrollton TX

Requirement: Must be a LVN or RN with prior MDS experience. Prior experience with appeals, denials, and audits preferred.

This is NOT a Remote position. Must be located in the Dallas/Ft. Worth area as this is a Hybrid position based out of our Carrollton office.

Job Summary

Responsible for managing denied claims and payer audits, preparing and submitting appeal letters and medical records, reviewing clinical documentation for medical necessity, validating coding accuracy, identifying trends in denials, collaborating with MDS team and facility teams to improve outcomes, and ensuring compliance with Medicare, Medicaid, and commercial payer requirements. This position serves as the primary resource for revenue recovery through effective denial prevention, appeal management, and documentation integrity initiatives.

Key duties:

• Review and analyze denied claims
• Draft and submit appeal and reconsideration letters
• Validate ICD-10, CPT, HCPCS, and coding as applicable
• Support ADRs, UPICs, TPE, RAC, and payer audits
• Track appeal outcomes and denial trends
• Educate clinical staff on documentation deficiencies
• Recover lost revenue through successful overturn of denials
• Maintain compliance with payer and regulatory requirements

Continuum Rehab Group provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.