Denials and Appeals Specialist (Level 3)

Denials and Appeals Specialist (Level 3) Department: Revenue Cycle Employment Type: Permanent - Full Time Location: HQ Reporting To: Revenue Cycle Manager Description Aspire Allergy & Sinus is seeking a full-time Medical Accounts Receivable Specialist (Level 3) to serve as a subject matter expert responsible for resolving complex, high-dollar, and systemic reimbursement issues. This role evaluates assigned payer accounts, including working rejections, invalid and denied claims, appeals, escalated patient account concerns, and follow-up activities to bring accounts to final resolution in a timely manner and within industry-standard benchmarks. The Level 3 AR Specialist also identifies root causes of reimbursement challenges, supports Accounts Receivable operations across all financial classes as needed, and ensures compliance with industry regulations, practice protocols, and company policies while driving overall revenue cycle performance. Schedule: Monday-Thursday 8 am- 5 pm Friday 8 am- 12 pm (40 hour work week) This position will be fully onsite at our HQ office located at 5929 Balcones Dr #200, Austin, TX 78731 What your day will look like Resolve highly complex and high-dollar reimbursement issues. Perform root cause analysis on denial trends and payer behavior. Manage systemic payer issues affecting multiple claims or locations. Serve as the escalation point for Level 1 and Level 2 AR Specialists, including the resolution of the most complex patient account and payer concerns. Handle sensitive and complex patient interactions, providing advanced problem-solving and de-escalation for challenging account issues. Develop advanced appeal strategies and resolution pathways. Interpret complex payer policies, coding rules, and reimbursement logic. Identify breakdowns in payer processes and recommend corrective action. Support process improvement initiatives across the revenue cycle. Provide guidance on complex claim scenarios and payer disputes. Review and approve account write-offs and adjustments up to $1,000; elevate amounts exceeding this threshold for management approval. Assist with standard Level 1 and Level 2 Accounts Receivable responsibilities across all financial classes as business needs require. Knowledge & Skills Needed to be Successful Exceptional ability to investigate complex data sets, perform root cause analysis on denial trends, and solve ambiguous billing or reimbursement puzzles independently Expert-level mastery of insurance workflows, advanced appeal strategies, coding rules, and diverse payer reimbursement logic Strong capacity to navigate high-dollar disputes and confidently implement advanced resolution pathways under minimal supervision Ability to articulate complex policy concepts clearly, serving as an approachable technical resource and mentor to junior staff Excellent written and verbal communication skills Ability to prioritize and manage multiple workflows and deadlines Must possess the ability to maintain effective working relationships with patients, medical staff and the public Must possess the ability to react calmly and effectively in a difficult or emergent situation, including de-escalating sensitive patient concerns. Supervisory responsibilities Direct Supervision: This role does not have formal direct reports (e.g., hiring, firing, or formal performance reviews). Functional Leadership: Acts as an informal technical authority and team lead within the AR department. Escalation & Mentorship: Responsible for monitoring, guiding, and reviewing the work of Level 1 and Level 2 AR Specialists on escalated, high-dollar cases to ensure accurate resolution. Conduct 1:1 meetings with department and cross-departmental teams to share denial trends. Required Education and Experience: Minimum of 5-7 years of medical billing, collections, and accounts receivable experience within a healthcare environment. Proven track record of independently resolving high-dollar, complex denials and dealing directly with difficult payer scenarios. Advanced proficiency with electronic health record (EHR) systems, clearinghouses, and medical billing software. High School Diploma or higher Preferred education and experience: Certified Revenue Cycle Specialist (CRCS), Certified Professional Coder (CPC), or equivalent revenue cycle certification. Prior experience in a \"Tier 3\" or Senior/SME AR role, or experience auditing insurance reimbursement workflows. Experience utilizing data analytics tools (e.g., advanced Excel, Tableau, or Power BI) to track and report on denial trends. Experience in Allergy & Sinus Specialty Experience with NextGen EHR Benefits & Perks Medical, Dental and Vision Insurance Generous Paid Time Off and Paid Holidays 401(k) + Generous Employer Match Life Insurance Gym Membership Discounts Aspire Allergy & Sinus is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. #J-18808-Ljbffr Aspire Allergy & Sinus