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

Practices that hire denial & appeals specialists through Staffing For Doctors

Each practice gets a denial & appeals specialist trained on the EHR, payers, and workflows specific to that specialty.

Anesthesiology

Prior Authorization Specialist

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Cardiology

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Critical Care

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Diagnostic Radiology

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Emergency Medicine

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ENT (Otolaryngology)

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Family Medicine

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Fertility / Reproductive Endocrinology

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General Surgery

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Geriatrics

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GI (Gastroenterology)

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Hematology

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Hospice

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Hospitalists

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Integrative / Functional Medicine

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Internal Medicine

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Medical Genetics

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Multi-Specialty

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Neonatal

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Nephrology

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Nuclear Medicine

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Obstetrics and Gynecology

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Oncology

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OT (Occupational Therapy)

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Pathology

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Pediatrics

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Physical Medicine and Rehabilitation

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Podiatry

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Preventive Medicine

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Pulmonology

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Radiation Oncology

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Radiology

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Sleep Medicine

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Telemedicine / Virtual-Only Practices

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Urology

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Vascular Surgery

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Weight Management

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Wellness / Integrative Medicine

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Wound Care / Hyperbaric

Prior Authorization Specialist - HBO2

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

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