Clinical Denial Specialist

Job description

Job Family: Medical Assistant Travel Required: None Clearance Required: None 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‑related reasons for denial. - Coordinate clinical denial cases with nurse reviewers, coding, utilization management, and revenue cycle teams to determine appeal viability. - Assemble and submit complete appeal packets, ensuring inclusion of appropriate clinical documentation and payer‑specific requirements. - Submit appeals via payer portals, secure fax, or mail, and confirm receipt to ensure timely adjudication. - Perform systematic appeal follow‑up at defined intervals until final claim resolution is achieved. - Track denial and appeal activity, maintaining accurate documentation within hospital and payer systems. - Identify denial trends and recurring issues and communicate findings to leadership to support process improvement initiatives. - Adhere to all hospital policies, payer guidelines, and regulatory requirements related to claims and appeals processi...