Clinical Denials and Appeals Specialist

We are seeking an experienced Clinical Denials and Appeals Specialist to join our Denials Management team. This role is responsible for reviewing complex payer denials and developing high-quality, evidence-based appeal letters that maximize reimbursement recovery for our healthcare clients.

The ideal candidate is a strong clinical reviewer and exceptional writer who can analyze medical records, identify weaknesses in payer determinations, and craft persuasive appeals supported by clinical documentation, regulatory guidance, and payer-specific requirements. The majority of this role is dedicated to appeal generation, appeal strategy, and overturning clinical denials.

Key Responsibilities

Appeal Development and Submission

• Generate comprehensive first-level, second-level, and escalated appeal letters for denied claims.
• Develop compelling clinical arguments using medical records, physician documentation, industry standards, and payer policies.
• Create appeal packages with all required supporti... Click Apply to read the full job description.