Denial Specialist

Reports to: Director of Accounts Receivable Employment Type: Full-Time; Non-Exempt Location: Chicago, IL Work Type: On-Site Department: Accounting Schedule: Monday through Friday, 9:00 AM to 5:00 PM Pay Range: $26.00 - $31.00 per hour Position Overview The Denial Specialist supports Vivia Health’s mission, patient-relations philosophy, and financial sustainability by researching, resolving, and helping prevent denied, rejected, or underpaid healthcare claims. This role reviews payer responses and account documentation, identifies denial root causes, prepares accurate corrections, reconsiderations, and appeals, follows payer and regulatory requirements, documents actions in approved systems, and collaborates with clinical, coding, billing, registration, authorization, and finance partners. The position requires strong attention to detail, timely follow-through, professional communication, billing integrity, and careful protection of patient information. The Denial Specialist is expected to work onsite during scheduled work hours, use approved organizational systems, and maintain auditable documentation that supports timely reimbursement and compliance. Key Responsibilities Claims Review and Denial Resolution Review assigned denied, rejected, or underpaid claims and related remittance information to determine the denial reason, payer requirement, and next appropriate action. Validate relevant claim, eligibility, authorization, coding, documentation, registration, billing, and payer information before preparing corrections or appeals. Prepare and submit accurate claim corrections, reconsiderations, and appeals with required supporting documentation, using approved channels and within applicable deadlines. Prioritize assigned accounts based on filing or appeal deadlines, account value, aging, organizational policy, and manager direction. Payer Follow-Up and Internal Coordination Contact payers and internal partners to obtain claim status, clarify requirements, resolve barriers, and confirm next steps. Route matters requiring licensed clinical judgment, coding authority, or specialized review to the appropriate team member or department. Collaborate with clinical, coding, billing, registration, authorization, and finance partners to support accurate claim resolution and prevent repeat denials. Escalate at‑risk, high‑value, time‑sensitive, or recurring denial issues promptly to the supervisor or appropriate leadership contact. Documentation, Compliance, and Billing Integrity Maintain complete, accurate, and timely account notes, work‑queue status updates, contact records, decisions, actions taken, and follow‑up dates in the designated system. Follow Vivia Health policies for privacy, security, records management, payer communications, billing integrity, approved communication platforms, professional boundaries, and use of electronic systems. Access, use, and disclose protected health information only as authorized and only to the extent needed to perform assigned duties. Cooperate with monitoring, audits, investigations, education, and corrective actions related to billing, documentation, quality, compliance, privacy, or security. Productivity, Quality Improvement, and Professional Expectations Meet established quality, productivity, timeliness, service, communication, and attendance expectations. Metrics are set and communicated separately and may be adjusted based on business need. Identify denial trends and likely root causes; communicate findings and participate in prevention, education, workflow improvement, or corrective‑action efforts. Maintain Paychex timekeeping accuracy by clocking in and out as required, reviewing time records, reporting discrepancies promptly, and following attendance, punctuality, meal‑period, break, and overtime procedures. Complete required orientation and ongoing training; raise compliance, privacy, safety, or quality concerns through approved channels. Perform other related duties consistent with the role’s purpose, qualifications, and level of responsibility. Qualifications Required Qualifications High school diploma or equivalent, or an approved combination of education and directly related experience. 1 or more years of healthcare billing, claims, denials, accounts receivable, payer follow‑up, revenue cycle, or closely related experience. Working knowledge of healthcare claim and remittance concepts, payer correspondence, timely filing, appeal processes, and account documentation. Ability to use electronic health record, patient accounting, payer portal, document‑management, spreadsheet, email, and collaboration tools after training. Ability to read and interpret detailed payer and account information, perform basic calculations, organize a changing workload, and communicate clearly in writing and verbally. Preferred Qualifications Experience with Medicare, Medicaid, managed care, commercial insurance, behavioral health billing, home‑based care billing, or Illinois payer processes relevant to the organization. Experience using AthenaOne, payer portals, clearinghouse tools, Microsoft Excel, SharePoint, Teams, Outlook, or other revenue cycle systems. Coursework, certification, or training in medical billing, coding, revenue cycle, health information, compliance, or a related healthcare administrative field. Experience identifying denial trends, supporting root‑cause analysis, and contributing to workflow improvement or denial prevention efforts. Work Environment and Physical Requirements This is primarily an onsite, computer‑and telephone‑based role. The employee regularly communicates, reads detailed information on screens and documents, enters data, and remains in a stationary position for portions of the workday, with the ability to change position as needed. The employee may occasionally move records or office materials weighing up to 20 pounds. The employee must maintain a secure workspace, use approved technology, safeguard Vivia Health equipment and confidential information, and promptly report work‑related injuries, privacy issues, security concerns, or safety concerns. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. #J-18808-Ljbffr Vivia