Claims Specialist

Healthcare Claims Denial & AR Management Specialist

Contract to Hire

Onsite - Addison TX 75001

About the Company

Our client is a healthcare revenue cycle and medical billing organization dedicated to helping healthcare providers maximize reimbursement accuracy and efficiency. They partner with practices and providers to manage the full claims lifecycle — from submission through resolution — while maintaining strict compliance with payer and regulatory standards.

Job Description

We're seeking a detail-oriented Healthcare Claims Denial Management Specialist to identify, analyze, and resolve denied or underpaid medical insurance claims. This role is critical to ensuring accurate and timely reimbursement, working cross-functionally with payers, internal billing teams, and healthcare providers to reduce denial rates and improve revenue cycle performance.

What You'll Be Responsible For

• Reviewing and analyzing denied, underpaid, and rejected medical claims to determine root causes
• Correcting claim errors, updating coding or documentation as needed, and resubmitting claims to payers within required timeframes
• Following up with insurance companies to resolve outstanding denials and secure payment
• Communicating directly with insurance representatives to verify claim status and resolve discrepancies
• Maintaining detailed documentation of actions, correspondence, and outcomes in billing/practice management systems
• Identifying denial patterns and trends across payers, coding categories, or service lines
• Collaborating with coding, billing, and clinical teams to prevent future denials through process improvements and training
• Preparing and submitting formal appeals with supporting medical records, coding references, and payer policy documentation
• Tracking appeal outcomes and ensuring compliance with appeal deadlines and payer regulations
• Ensuring claim corrections and submissions comply with federal, state, and payer-specific regulations
• Generating denial reports, analyzing metrics, and providing insights to leadership
• Monitoring KPIs such as denial rate, appeal success rate, and days in accounts receivable (A/R)

Required Experience/Skills

• 2–4 years of experience in medical billing, claims processing, or denial management within a healthcare or payer environment
• Strong knowledge of revenue cycle processes
• Proficiency with CPT/HCPCS and ICD-10 coding
• Familiarity with insurance payer rules (commercial, Medicare, Medicaid)
• Solid understanding of medical terminology
• Proficiency with EMR/EHR systems, clearinghouses, and billing software
• Strong analytical skills with attention to detail and the ability to identify trends and interpret payer policies
• Excellent verbal and written communication skills
• Strong organizational skills with the ability to manage multiple priorities and deadlines

Nice-to-Haves

• CPC, CPB, or other AAPC/AHIMA certification
• Experience in high-volume claims environments
• Familiarity with appeals and audit processes

Education

• High school diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration, business, or related field preferred

Pay Summary

• $27/hr. W2

Apply Now!

Denial Management Specialist, Medical Billing, Claims Processing, Revenue Cycle Management, CPT, HCPCS, ICD-10, Medical Coding, Insurance Appeals, EMR, EHR, Accounts Receivable, Healthcare Billing, Payer Relations, Medicare, Medicaid, AAPC, AHIMA, CPC, CPB