Medical Billing Denial Specialist

About the role

The Medical Billing Denial Specialist analyzes and resolves insurance claim denials for Critical Care, Pulmonary and Sleep Associates providers. The role prepares appeals, recovers reimbursement, identifies denial trends and supports team education.

Key responsibilities

• Review denied claims for billing and coding accuracy, route corrections, and submit appeals or reconsiderations.
• Identify denial trends, communicate findings and help prevent recurring errors.
• Collaborate with coders, Revenue Cycle Operations Manager and other team members to resolve coding and billing questions.
• Maintain knowledge of compliance requirements and regulatory guidelines.
• Provide exceptional customer service to patients, insurers and internal staff, documenting outcomes and tracking requests.

Required profile

• 2‑3 years of hands‑on experience in a medical billing department with strong denial follow‑up and appeals experience.
• Strong understanding of payer websites and appeal processes for commercial and government payers (VA, Tricare, Medicare, Medicaid, Medicare Advantage).
• High School Diploma or GED required.

Required skills

• EPIC EHR with Resolute Professional Billing module (preferred).
• Microsoft Outlook, Word and Excel.
• Proficiency using payer websites and internet research tools.

What we offer

• Competitive hourly pay with benefits effective on the date of hire.
• Comprehensive medical, dental and vision coverage (company pays 80‑85% of premiums).
• Life, AD&D and optional additional insurance at group rates.
• PTO, holiday pay and 401(k) with company contribution after eligibility.