RCM Denials Specialist (Denial Recovery)

Denials Specialist

Insight Global is seeking a fully remote Denials Specialist for our client specializing in orthopedic denials recovery. The RCM Denials Specialist is responsible for recovering revenue lost to denied and underpaid orthopedic medical claims by executing payer-specific denial recovery workflows with a high level of accuracy and efficiency. This role focuses on post-payment denials and unpaid claims, managing appeals from initial denial through final resolution. The specialist works within standardized playbooks and performance metrics to directly impact client cash flow and recovered revenue. This is a production-driven, outcomes-focused role suited for professionals who thrive in structured, KPI-driven environments and take ownership of financial results.

Key Responsibilities:

• Denial Recovery & Appeals - Work assigned denial and underpayment claim queues, including post-pay denials, medical necessity, bundling, timely filing, and workers' compensation claims
• Prepare, submit, and track appeals in accordance with payer- and CPT-specific guidelines
• Follow up with insurance payers via phone, online portals, and written correspondence until final resolution
• Ensure timely progression of claims and avoid preventable delays in follow-up

Documentation & Accuracy:

• Accurately document all claim actions, appeal submissions, and payer communications
• Upload, organize, and maintain required clinical and billing documentation
• Maintain clean, complete, and audit-ready records suitable for internal leadership and client review
• Meet high accuracy standards while maintaining daily and weekly productivity targets

Workflow Execution & Collaboration:

• Adhere to standardized recovery playbooks and escalation thresholds
• Escalate complex or unusual denial patterns appropriately
• Collaborate with leadership, QA, and strategy teams to improve recovery outcomes
• Identify and report payer trends, denial patterns, and workflow improvement opportunities