Denial Management Specialist

Ellis County Coalitn For Hlth•Waxahachie, TX

2d•Onsite

About The Position

Hope Health is seeking a Denial Management Specialist to strengthen our revenue cycle by identifying, appealing, and resolving denied claims. This role directly supports the financial sustainability of our health center by recovering reimbursable revenue and reducing future denials through root-cause analysis.

Requirements

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.

Nice To Haves

Certified Professional Coder (CPC) or Certified Revenue Cycle Representative (CRCR) a plus, not required.

Responsibilities

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.