Denials and Appeals Specialist

Denials and Appeals Specialist

Accounts Receivable | Claims Follow-Up | Denial Management

GlyCare is seeking an experienced Denials and Appeals Specialist to join our growing billing team in Jacksonville, Florida.

This position supports a hospital-based medical group operating across multiple states. The role is ideal for someone with experience in medical billing, insurance accounts receivable, claim follow-up, denial management, payment research, or other revenue cycle functions who is ready to expand their knowledge and contribute within a growing organization.

The successful candidate will be comfortable researching claim issues, communicating with insurance companies, documenting follow-up activity, and taking ownership of accounts through resolution. Experience in every area listed below is not required; however, candidates should have a strong medical billing foundation, a willingness to learn, and the ability to independently work through billing and reimbursement issues.

What You’ll Do

• Manage insurance accounts receivable and follow up on unpaid, delayed, rejected, underpaid, or denied claims.
• Review claim status, payer responses, and account history to determine the appropriate next steps.
• Contact commercial insurance plans, Medicare, Medicaid, and managed care payers to research and resolve claim issues.
• Correct and resubmit claims when appropriate.
• Work claims involving eligibility, coordination of benefits, authorization, documentation, coding, provider enrollment, claim submission, reimbursement, or payer processing issues.
• Review explanations of benefits, electronic remittance advice, denial messages, and payer correspondence.
• Prepare and submit claim reconsiderations, corrected claims, or appeals when needed.
• Document all payer communication, follow-up activity, and resolution steps clearly and accurately.
• Identify recurring payer, provider, location, or claim-processing issues and escalate trends to leadership.
• Use Excel, billing-system reports, and internal tracking tools to organize follow-up and monitor outstanding accounts.
• Collaborate with billing, credentialing, clinical operations, providers, and leadership to support timely reimbursement and reduce preventable denials.
• Assist patients with billing questions, insurance concerns, balances, or account-related issues in a professional and respectful manner.
• Support payment research, patient balance review, claim corrections, and limited payment-posting functions as needed.
• Cross-train in additional medical billing and revenue cycle responsibilities as the organization grows.

What We’re Looking For

• At least two years of recent experience in medical billing, insurance follow-up, accounts receivable, denial management, payment posting, claims processing, or a related revenue cycle role.
• Experience in a physician practice, hospital-based practice, specialty group, medical billing company, health system, or similar healthcare setting.
• Working knowledge of the medical billing and insurance reimbursement process.
• Ability to research why a claim was rejected, denied, delayed, or underpaid and determine the appropriate action.
• Experience working with commercial insurance, Medicare, Medicaid, managed care, or other healthcare payers.
• Ability to read payer correspondence, claim status information, explanations of benefits, and electronic remittance advice.
• Professional communication skills when speaking with insurance representatives, patients, providers, and internal team members.
• Strong organization, documentation, time-management, and follow-through skills.
• Ability to manage multiple priorities and continue working an issue until it is resolved or appropriately escalated.
• Comfort learning new payer requirements, systems, workflows, and responsibilities.
• Experience using electronic medical record or practice-management software.
• Basic to intermediate Microsoft Excel skills.

Experience That May Be a Good Fit

Candidates may have held titles such as:

• Medical Billing Specialist
• Medical Accounts Receivable Specialist
• Insurance Follow-Up Representative
• Revenue Cycle Specialist
• Denial Management Specialist
• Claims Resolution Specialist
• Patient Account Representative
• Medical Collections Specialist
• Payment Posting Specialist
• Physician Billing Specialist
• Hospital Billing Representative
• Medical Claims Examiner or Processor

Key Traits for Success

• Persistent and resourceful when researching claim or payer issues.
• Able to work independently while knowing when to ask questions or escalate an issue.
• Comfortable in a fast-paced environment where priorities may change.
• Detail-oriented and consistent with account documentation.
• Interested in understanding how different areas of the revenue cycle affect reimbursement.
• Willing to cross-train and help support the broader billing department.
• Positive, dependable, and team-oriented.
• Motivated by resolving problems rather than simply completing assigned tasks.

Education

A college degree is not required. Relevant hands-on medical billing, insurance, claims, or revenue cycle experience is valued more heavily than formal education.

Professional billing or coding certifications are welcomed but are not required.

Compensation and Benefits

Salary range: $56,000–$68,000 annually, based on experience and qualifications.

Additional information regarding company benefits will be discussed during the interview process.

Work Schedule and Location

This is a full-time, on-site position located in Jacksonville, Florida .

Schedule: Monday through Friday

Applicants must be able to reliably commute to the Jacksonville office.

GlyCare is a growing organization, and this role offers the opportunity to broaden your revenue cycle knowledge, cross-train in additional functions, and contribute to the development of improved billing processes.