Revenue Cycle Clinical Denials Specialist

Job Description

Job Description

Do you have experience with hospital revenue cycle, denials management, and insurance appeals?

Join one of Fort Worth's leading healthcare systems and put your clinical revenue cycle expertise to work!

Position: Revenue Cycle Clinical Denials Specialist

Location: Fort Worth, TX | Onsite

Pay: $35HR

Schedule: Monday - Friday | Business Hours

Status: Temp

Job Description:

The Revenue Cycle Clinical Denials Specialist plays a vital role in maximizing hospital reimbursement by researching, analyzing, and resolving complex clinical claim denials. This position is responsible for reviewing medical documentation, identifying root causes of denials, preparing detailed appeal letters, tracking denial trends, and collaborating with clinical and revenue cycle teams to improve reimbursement outcomes and prevent future denials.

Job Duties:

• Investigate and resolve complex clinical insurance denials including medical necessity, authorization, referrals, level of care, and late notifications.
• Review medical records, billing information, and clinical documentation to determine root causes of denied claims.
• Prepare and submit detailed, well-supported appeal and reconsideration letters in accordance with CMS, Medicaid, and commercial insurance guidelines.
• Monitor and trend denial activity, recoveries, and reimbursement outcomes.
• Identify recurring denial patterns and recommend process improvements to reduce future denials.
• Collaborate with clinical departments, physicians, and revenue cycle leadership to improve reimbursement performance.
• Review payer policy updates and communicate reimbursement risks to leadership.
• Maintain accurate documentation while ensuring compliance with regulatory and organizational standards.

A GREAT Candidate Will Have:

• Minimum 3 years of recent hospital revenue cycle, medical billing, denials management, and insurance collections experience.
• Experience writing insurance appeals and overturning clinical denials.
• Strong understanding of CPT, HCPCS, ICD-10 coding, medical terminology, insurance billing, and reimbursement guidelines.
• Knowledge of CMS, Medicaid, commercial payer policies, and hospital revenue cycle processes.
• Advanced analytical, problem-solving, and root cause analysis skills.
• Excellent written communication and professional business writing abilities.
• Intermediate to advanced Microsoft Excel skills with experience analyzing denial data.
• Prior Epic Resolute (Hospital Billing) experience is required.
• LVN, CPC, CIC, COC, or CPB certification is highly preferred but not required.

Application Process Includes:

• Background Check
• Drug Screen
• Skills Assessment
• Flu shot/ Tb Test

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