Denials and Appeals Specialist

Required

• 5+ years of medical billing, claims, or revenue cycle experience in a non-traditional setting
• Strong understanding of the healthcare claim lifecycle, adjudication, denials, and appeals
• Knowledge of utilization review and medical necessity determinations
• Familiarity with patient appeals, appeal levels, deadlines, peer-to-peer review, and external/independent review
• Ability to communicate persuasively with payer representatives and remain composed under pressure
• Strong patient communication skills with empathy and clarity
• Ability to read and interpret EOBs, denial letters, plan documents, and medical necessity criteria such as MCG or InterQual
• Strong written communication skills
• Detail-oriented with consistent follow-through on deadline-driven work
• Proficiency in Excel and MS Office
• Ability to manage a high-volume caseload independently
• High school diploma or equivalent

Preferred

• Experience reading UB-04 and CMS-1500 claim forms
• Familiarity with payer portals such as Availity, Optum, Cigna, Aetna, and BCBS
• Experience with state Department of Insurance complaints or external review organizations
• Utilization review, clinical appeals, or payer-side claims experience
• Patient-facing billing or financial counseling experience
• Experience in a small business environment

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance