Billing Specialist – Denials & Revenue Recovery

Full Time

Clarion, IA, US

Fort Dodge, IA, US

Mason City, IA, US

Spencer, IA, US

30 days ago

Requisition ID: 1103

ApplySalary Range:

$18.00 To $26.00 Hourly

Job Title

Billing Specialist – Denials & Revenue Recovery

Department

Revenue Cycle / Finance

Reports To

Revenue Cycle Manager / Billing Manager

FLSA Status

Non-Exempt (recommended)

Location

FQHC – Multi-Site (Remote Work Available after 90 days)

Position Summary

The Billing Specialist – Denials & Revenue Recovery is responsible for identifying, analyzing, correcting, and resubmitting denied and underpaid claims to ensure accurate and timely reimbursement for services provided by the Federally Qualified Health Center (FQHC). This role focuses on denial prevention, appeal submission, payer follow-up, and continuous improvement of billing workflows in compliance with HRSA, Medicare, Medicaid, and commercial payer requirements.

Essential Duties & ResponsibilitiesDenial Management & Rework

• Review, research, and resolve denied, rejected, or underpaid claims across all payer types (Medicaid, Medicare, Medicare Advantage, commercial, and grant-related services).
• Identify root causes of denials, including coding errors, eligibility issues, authorization deficiencies, documentation gaps, and payer-specific billing rules.
• Correct claims and resubmit within payer-specific timely filing limits.
• Prepare and submit first-level and second-level appeals with supporting documentation as required.
• Track denial trends and recommend corrective actions to prevent recurrence.

FQHC-Specific Billing Responsibilities

• Apply FQHC PPS/APM billing rules accurately for Medicaid and Medicare.
• Ensure correct encounter billing, including wraparound and crossover claims where applicable.
• Verify proper use of modifiers, place of service, revenue codes, and diagnosis codes for FQHC services.
• Collaborate with clinical and coding staff to resolve documentation or medical necessity issues impacting reimbursement.

Payer Communication & Follow-Up

• Conduct payer follow-up via portals, phone calls, and written correspondence.
• Maintain detailed documentation of payer communications and claim status updates in the billing system.
• Escalate unresolved claims or payer discrepancies to the Billing Manager as appropriate.

Reporting & Performance Monitoring

• Maintain denial logs and work queues to ensure timely resolution.
• Monitor aging reports and prioritize high-dollar or time-sensitive claims.
• Assist with monthly denial trend analysis and performance metrics (e.g., denial rate, recovery rate, days in A/R).
• Support audits, payer reviews, and internal compliance activities related to billing and reimbursement.

Compliance & Quality Improvement

• Ensure compliance with HRSA, CMS, state Medicaid, and payer billing requirements.
• Follow all organizational policies related to privacy, HIPAA, and compliance.
• Participate in process improvement initiatives to improve clean claim rates and reduce denials.
• Stay current on billing regulations, payer rule changes, and FQHC reimbursement updates.

Required Qualifications

• High school diploma or equivalent required.
• Minimum of 2 years of medical billing experience, with demonstrated denial management experience.
• Strong understanding of medical billing, claims processing, and payer rules.
• Experience working with Medicaid and Medicare required.
• Proficiency with EHR and billing systems (Epic preferred).
• Strong attention to detail, analytical skills, and ability to work independently.

Preferred Qualifications

• Prior experience in an FQHC or community health center.
• Knowledge of FQHC PPS/APM billing, wraparound claims, and encounter-based reimbursement.
• Certified Professional Biller (CPB), Certified Coding Associate (CCA), or similar certification.
• Experience with Medicare Advantage plans and denial appeals.
• Familiarity with revenue cycle reporting and denial trend analysis.

Key Competencies

• Denial analysis and root-cause identification
• Claims correction and appeal writing
• Payer communication and follow-up
• Regulatory and payer compliance
• Time management and prioritization
• Cross-department collaboration

Physical & Work Requirements

• Prolonged periods of sitting and computer use.
• Ability to manage multiple work queues and deadlines.
• Occasional travel between clinic sites may be required.

Performance Expectations

• Timely resolution of assigned denial work queues.
• Reduction in repeat denials through corrective action feedback.
• Accurate and compliant claim rework and resubmission.
• Consistent documentation and communication within the billing system.
• Positive collaboration with clinical, coding, and registration teams.