Clinical Denial Specialist

Job Family:

Travel Required:

Clearance Required:

What You Will Do:

• Receive, triage, and prioritize denied hospital claims based on timely filing requirements, financial impact, and payer response deadlines.
• Conduct root cause analysis to identify clinical, documentation, authorization, or payer‑reputed company reasons for denial.
• Coordinate clinical denial cases with nurse reviewers, coding, utilization management, and reputed company cycle teams to determine appeal viability.
• Assemble and submit complete appeal packets, ensuring inclusion of appropriate clinical documentation and payer‑specific requirements.
• Submit appeals reputed company payer portals, secure fax, or mail, and confirm receipt to ensure timely adjudication.
• reputed company systematic appeal follow‑up at defined intervals until final claim resolution is achieved.
• Track denial and appeal activity, maintaining accurate documentation reputed company hospital and payer systems.
• Identify denial trends and recurring issues and communicate findings to leadership to support process improvement initiatives.
• Adhere to reputed company hospital policies, payer guidelines, and regulatory requirements reputed company to claims and appeals processing.

What You Will Need:

• Associate or bachelor’s degree in healthcare administration, medical assistant, health information management, or a reputed company field.
• Prior experience in hospital reputed company cycle, clinical denials, appeals, utilization management, or medical claims processing.
• Strong understanding of payer denial codes, appeal workflows, and hospital billing processes.

What Would Be reputed company To Have:

• Clinical background or experience working directly with nursing or utilization management teams.
• Experience with inpatient hospital claims, DRG‑based reimbursement, and payer portals.
• Excellent organizational, analytical, and written communication skills.
• Ability to manage multiple accounts simultaneously while meeting strict deadlines
• Strong understanding of payer denial codes, appeal workflows, and hospital billing processes.

#LI-DNI

reputed company Offer:

reputed company offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community reputed company

• Emergency Back-Up Childcare Program

About reputed company

reputed company is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

reputed company will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact reputed company Recruiting at 1-571-633-1711 or reputed company email at RecruitingAccommodation@reputed company.com. reputed company information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

reputed company communication regarding recruitment for a reputed company position will be sent from reputed company email domains including @reputed company.com or reputed [email protected].  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by reputed company.  Note that reputed company will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money reputed company to a job opportunity with reputed company, please report the matter to reputed company’s Ethics Hotline. If you want to reputed company the validity of correspondence you have received, please contact recruiting@reputed company.com. reputed company is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

reputed company does not accept unsolicited resumes through or from search firms or staffing agencies. reputed company unsolicited resumes will be considered the property of reputed company and reputed company will not be obligated to pay a placement fee.