Medical Denials Specialist

Denials Strike Team Specialist

Location:

Remote/Hybrid (as assigned)

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

Employment Type:

4 Month Contract

We are seeking a highly motivated Denials Strike Team Specialist to join our Revenue Cycle team and play a critical role in reducing aged accounts receivable and maximizing reimbursement recovery. This position focuses on investigating, resolving, and preventing denied or aging claims from timing out due to timely filing limitations.

The ideal candidate is an independent, proactive problem solver with strong analytical skills and a proven background in denial management within a provider environment. This individual will leverage Athena, payer portals, Excel, and Google Sheets to research denials, identify root causes, submit appeals and corrected claims, and drive claim resolution with minimal supervision.

• Review and work aged accounts receivable, with a focus on 80+ day aging buckets.
• Identify claims approaching timely filing deadlines and take corrective action to prevent revenue loss.
• Investigate denied claims and determine the root cause of denial.
• Research payer guidelines, policies, and filing requirements to ensure compliant resubmissions.
• Prepare and submit appeals, reconsiderations, and corrected claims.
• Utilize payer portals to obtain denial details, supporting documentation, and claim status information.
• Track and maintain accurate work activity within Athena, Excel, and Google Sheets.
• Collaborate with Revenue Cycle and Billing teams to resolve complex claim issues.
• Reduce aged A/R inventory and improve reimbursement recovery outcomes.
• Prevent avoidable write-offs through proactive follow-up and issue resolution.
• Build and maintain positive working relationships with payer representatives to facilitate claim resolution.

• Minimum 6 months to 3 years of denials management experience within a healthcare provider environment.
• Experience working with denied claims, accounts receivable, and reimbursement follow-up.
• Proficiency navigating payer portals to research denials and submit supporting documentation.
• Experience utilizing Athena for worklists, claim review, denials management, and workflow execution.
• Strong analytical and investigative skills with the ability to independently determine why claims were denied and implement solutions.
• Advanced proficiency with Excel and/or Google Sheets, including:
• Formulas
• Sorting and filtering
• Data analysis functions
• Comfortable working within a Mac-based environment utilizing dual monitors.
• Excellent verbal and written communication skills.
• Strong organizational and time management abilities with the capability to prioritize workload effectively.
• Proven ability to work independently with minimal oversight and take ownership of claim resolution from start to finish.

• Experience with:
• Excel Pivot Tables
• VLOOKUPs and advanced spreadsheet functions
• Medicaid and commercial payer claim processing
• Aging reports and denial analytics
• Familiarity with AI tools and technology solutions.
• Experience with alternative healthcare billing models, including membership-based services.
• Process improvement mindset with the ability to identify workflow efficiencies.
• Experience developing training materials, workflows, or operational procedures.

• Take initiative and solve problems independently.
• Be highly reliable and accountable for deadlines and deliverables.
• Thrive in a fast-paced, evolving environment.
• Demonstrate strong professional communication in both internal and payer-facing interactions.
• Possess a sense of urgency when addressing aging claims and reimbursement challenges.
• Consistently seek solutions rather than escalating routine…