Denial Management Specialist

• Review, research, and resolve denied and underpaid claims across Medicare, Medicaid, and commercial payers.
• Draft and submit timely, well-documented appeals with supporting clinical and billing documentation.
• Identify denial trends and root causes; recommend workflow or documentation changes to prevent recurrence.
• Follow up with payers on outstanding appeals and escalate unresolved claims as needed.
• Collaborate with billing, coding, and front-desk staff to correct upstream errors driving denials.
• Track denial and appeal outcomes; report trends to leadership for QI/QA and revenue cycle reviews.
• Stay current on payer policy changes affecting FQHC billing, including PPS/UDS-related billing nuances.

• Knowledge of payer appeal timelines, medical necessity criteria, and FQHC-specific billing regulations.
• Skill in analyzing denial patterns and translating findings into practical process improvements.
• Skill in writing clear, well-supported appeal letters grounded in clinical and billing documentation.
• Ability to interpret EOBs, ERAs, and payer correspondence accurately and efficiently.
• Ability to collaborate across billing, coding, and clinical teams to correct root causes of denials.
• Ability to manage a high volume of appeals while meeting payer-specific filing deadlines.

• 2+ years of experience in medical billing, denial management, or revenue cycle, preferably in an FQHC or community health setting.
• Strong understanding of payer appeal processes, CPT/ICD-10 coding, and EOB/ERA interpretation.
• Experience with practice management or EHR billing systems (e.g., eClinicalWorks, NextGen, or similar).
• Strong analytical and written communication skills for appeals writing.
• Certified Professional Coder (CPC) or Certified Revenue Cycle Representative (CRCR) a plus, not required.

Job Type: Full-Time