Billing Denials Specialist

Billing Denials Specialist Position Summary
- The Billing Denials Specialist is responsible for managing the end-to-end denial and appeals process for the organization, including identifying, tracking, analyzing, and resolving payer claim denials. partners with clinical, coding, billing, and payer-relations staff to reduce future denials; and monitors trends to drive process improvements. Statement of Accountability
- Reports to: Manager of Billing Denials and Appeals QualificationsEducationLicensureWork ExperienceSkills/computer/ specific technicalOther qualifications, miscellaneousSpecify if qualifications are Required or Preferred
- Associate's or Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or a related field preferred; equivalent work experience considered.
Minimum of 2-4 years of experience in medical billing, claims denial management, appeals, utilization review, or revenue cycle operations.
Working knowledge of ICD-10, CPT, and HCPCS coding, medical terminology, and payer reimbursement methodologies.
Familiarity with Medicare, Medicaid, and commercial payer denial and appeal guidelines.
Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Certified Revenue Cycle Representative (CRCR) credential a plus.
Proficiency with electronic health record (EHR) and practice management/billing systems.
Achieving ResultsKey Components: assess, plan, evaluate, demonstrate initiative, quality of work, productivity
- Meets or exceeds established productivity and turnaround-time targets for denial resolution and appeal submission.
Successfully overturns a measurable percentage of denied claims through accurate, well-documented appeals.
Demonstrates SkillKey Components: competency, job knowledge, organizational skills, analytical skill, management of information, employee & patient safety
- Technical ExpertiseExpert-level understanding of denial types (clinical necessity, coding, authorization, timely filing, COB) and corresponding appeal strategies.
Strong command of payer contracts, fee schedules, and reimbursement logic across Medicare, Medicaid, and commercial lines of business.
Proficiency in hospital billing and revenue cycle systems (Epic) and payer web portals.
Familiarity with denial management and workflow automation platforms (e.g., Working knowledge of clinical documentation requirements, ICD-10-CM/PCS coding principles, and clinical criteria sets (InterQual, Milliman). Planning & CoordinatingKey Components: delegates, decision making, problem solving, management of resources
- Organizes and manages a high-volume caseload of denials and appeals to ensure timely, orderly processing.
Coordinates with coding, clinical documentation, case management, and billing teams to gather supporting documentation.
ProfessionalismKey Components: dependability, interpersonal skills, teamwork, patient first ethic, customer service, communication skills, punctuality/attendance, receptiveness to criticism, judgment, confidentiality
- Maintains confidentiality of patient information in accordance with HIPAA and organizational policy.
Exercises sound judgment and integrity when handling sensitive financial and clinical information. Washington Hospital Health System does not utilize any form of electronic chatting, such as Google chat for the purposes of interviewing candidates for employment. If you are contacted by any entity or individual attempting to engage you in this format, do not disclose any personal information and contact Washington Hospital Healthcare System.