Medical Denials Specialist

Location:

Remote

Pay Rate: $22.00 - $25.00/hour (based on experience)

We are seeking a detail-oriented and proactive Denials Specialist to join our Revenue Cycle team. In this role, you will be responsible for reviewing, researching, and resolving denied medical claims to ensure timely and accurate reimbursement. The ideal candidate has experience working in a provider-based healthcare environment, strong analytical skills, and the ability to independently investigate denial issues and drive claims to resolution.

This position requires a self-starter who is comfortable navigating multiple systems, working in a fast-paced environment, and collaborating with internal teams and payer representatives to resolve complex reimbursement challenges.

• Review denied claims through Athena worklists, payer portals, and other revenue cycle systems.

• Analyze denial reasons and identify root causes, including:

• Coordination of Benefits (COB)

• Eligibility issues

• Coding discrepancies

• Deductible and coverage-related denials

• Authorization and billing errors

• Conduct research using internal systems, payer guidelines, and billing resources to determine appropriate corrective action.

• Collaborate with internal Revenue Cycle and Billing teams to resolve claim issues and prevent future denials.

• Correct, resubmit, and track denied claims to ensure accurate reimbursement.

• Monitor and maintain denial worklists, backlog inventories, and aging accounts.

• Utilize Excel and Google Sheets to organize, track, and analyze denial trends.

• Access payer portals to obtain denial reports, review claim status, submit corrections, and follow up on outstanding claims.

• Communicate professionally with patients, customers, and payer representatives when payer-side corrections are not applicable.

• Support process improvement initiatives and contribute to workflow optimization efforts.

• Assist with evolving revenue cycle processes as the organization continues to enhance Athena system utilization.

• Minimum 6 months of denials management experience in a provider-based healthcare environment.

• Up to 3 years of denials and claims resolution experience preferred.

• Hands-on experience reviewing and resolving denied medical claims.

• Ability to independently identify denial causes and determine appropriate corrective actions.

• Experience working within Athena (Athenahealth), including denial review, worklists, and claim workflows.

• Familiarity with payer portals for claim research, denial reporting, and claim resubmissions.

• Strong knowledge of healthcare claims processing and reimbursement practices.

• Proficiency with Microsoft Excel and Google Sheets, including:

• Sorting and filtering data

• Basic formulas and reporting functions

• Experience with VLOOKUPs and Pivot Tables preferred

• Comfortable working in a Mac-based environment with dual monitors.

• Excellent problem-solving and critical-thinking skills.

• Strong written and verbal communication skills.

• Ability to work independently, manage priorities, and meet deadlines with minimal supervision.

• Experience in Accounts Receivable (AR) and claims resolution.

• Medicaid billing and reimbursement experience.

• Data entry and record management experience.

• Familiarity with AI tools and technology solutions.

• Experience working with alternative or membership-based billing models.

• Process improvement and workflow development experience.

• Experience assisting with training documentation or operational procedures.

• An independent problem solver who takes initiative and ownership of their work.

• Curious and analytical, with the ability to investigate issues thoroughly.

• Reliable, responsive, and accountable for meeting deadlines.

• Comfortable in a dynamic and evolving environment.

• Professional and confident when communicating with customers, payers, and internal stakeholders.

• Tech-savvy and adaptable to new systems and processes.

• $22.00/hour:
  Candidates with 6 months to 1 year of denials experience.

• Up to $25.00/hour:
  Candidates with advanced denials experience (up to 3 years) and strong Athena, payer portal, and claims resolution expertise.

This is a Contract position based out of Atlanta, GA.

The pay range for this position is $22.00 - $25.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other…