Denial & Appeal Specialist (Healthcare)

TL;DR

Denial & Appeal Specialist (Healthcare): Managing end-to-end denial processes and building appeals across a complex multi-payer book of business with an accent on pattern-level resolution and root cause analysis. Focus on reducing denial rates by analyzing 835 remittance files and coordinating with RCM platform teams.

Location: Remote (Must be based in the United States)

Salary: $21 – $27 per hour

Company

Reimagining healthcare access by delivering care directly to patients' homes using marketplace and last-mile technologies.

What you will do

• Manage denial buckets across multiple payer relationships using pattern-level resolution.
• Write and submit clinical and administrative appeals and escalate to peer-to-peer reviews.
• Analyze 835 remittance files to identify reason codes and trace root causes.
• Identify coding-driven denial trends and flag them for upstream correction.
• Collaborate with the RCM platform team to manage shared work queues.
• Build and maintain a detailed denial tracking log with aging and status tagging.

Requirements

• 3+ years of medical billing experience focused on denials and appeals.
• Experience with Medicaid managed care and Medicare Advantage payers.
• Proficiency in reading 835 remittance files and CARC/RARC codes.
• Experience with CMS-1500 and/or UB-04 billing.
• Strong written communication skills for composing appeals.
• Fluency with clearinghouse and RCM platforms.

Nice to have

• Working knowledge of ICD-10-CM, CPT, and HCPCS Level II coding.
• CPC, CCA, or CCS credentials.
• Experience with home health, preventive care, or value-based care billing.
• Prior experience in a lean or startup RCM environment.