Position

    Denial & Appeals Specialist

    Denials worked, appeals won, revenue recovered.

    A denial and appeals specialist owns the denial worklist - reading EOBs, identifying the root cause, drafting appeals with clinical justification, and tracking each appeal to a decision. They turn denied claims back into paid claims and feed root-cause findings into front-end fixes.

    What is a denial & appeals specialist?

    A denial and appeals specialist owns the denial worklist - reading EOBs, identifying the root cause, drafting appeals with clinical justification, and tracking each appeal to a decision. They turn denied claims back into paid claims and feed root-cause findings into front-end fixes.

    What a denial & appeals specialist does day-to-day

    Our denial specialists run the daily denial worklist, classify denials by CARC/RARC code, prioritize by dollar value, and route the corrective action - corrected claim, redetermination, peer-to-peer, or formal appeal. They track appeal outcomes and report trends so front-end errors get fixed at the source rather than re-worked downstream.

    Daily responsibilities of a denial & appeals specialist

    • Daily denial worklist triage by CARC/RARC and dollar value
    • Appeal letter drafting with clinical documentation
    • Peer-to-peer scheduling and coordination
    • Redetermination and reconsideration submission
    • Root-cause analysis and front-end feedback
    • Weekly denial-and-appeal KPI reporting

    Tools & EHRs supported

    AvailityWaystarChange HealthcareAthenaeClinicalWorksEpicKareoAdvancedMD

    Outcomes

    60%+
    Appeal win rate
    <8%
    Denial rate held
    70%
    Lower cost vs in-house
    Also serving denial & appeals specialists in

    Frequently asked questions

    About hiring a denial & appeals specialist from Staffing For Doctors.

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