AR Executives Denial Specialists | US Healthcare RCM | Multiple Openings
Denial Management & Appeals: Radiology, Cardiology, Ophthalmology, Pulmonary, Neurology, Vascular & Procedures
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About Us
Role Overview
You’ll also help stop denials from coming back by spotting patterns and flagging them so the root cause can be fixed upstream.
This is a production role for people who enjoy solving denials, not a reporting or analyst role.
Positions Available
Denial Specialist (2–4 years):
Work assigned denied claims, including root-cause review, correction, resubmission, and standard appeals.Senior Denial Specialist (4–7 years):
Handle complex and high-value denials, multi-level appeals, and aged denied AR, and support newer team members.
Candidates will be placed at the right level based on experience and assessment.
Key Responsibilities
- Work assigned denied claims end to end: review the EOB/ERA, interpret CARC/RARC codes, identify the true root cause, and take the action needed to get the claim paid.
- Categorize each denial accurately (e.g., eligibility/coverage, prior authorization, medical necessity, coding/modifier, bundling, timely filing, COB, duplicate, missing information, provider enrollment/credentialing) so trends can be tracked correctly.
- Decide the right resolution path for each denial: corrected claim, resubmission, reconsideration, or formal appeal.
- Write clear, well-supported appeals and reconsideration requests, attaching the right documentation (medical records, authorization proof, payer policy references, proof of timely filing).
- Handle specialty-specific denials, including prior authorization denials for imaging and procedures, medical necessity denials, modifier issues, global period and bundling (NCCI) edits, and professional vs. technical component billing.
- Track appeal deadlines and timely filing limits by payer, and prioritize denials by deadline, value, and age to prevent avoidable write-offs.
- Follow up on submitted appeals and reconsiderations through payer calls, portals, and clearinghouse tools until a final decision is received; escalate to the next appeal level when warranted.
- Work aged denied AR (60+, 90+, and 120+ days), including older backlog denials, and recover payment before claims become uncollectable.
- Work denials for New York plans, including NYS Government Employees (Empire Plan), Fidelis Care, EmblemHealth, BCBS, Medicare, Medicaid, and commercial payers.
- Identify recurring denial patterns by payer, code, specialty, or provider and report them to the Team Lead with examples, so front-end, coding, or billing fixes can be made.
- Flag claims that may indicate an overpayment or coding concern to the Team Lead instead of appealing them.
- Document every action, appeal, and outcome clearly and accurately in the practice management system.
- Meet daily productivity and quality targets.
- Follow HIPAA requirements and handle patient information securely at all times.
Required Skills
- 2+ years of hands-on US Healthcare denial management experience (not only AR calling).
- Hands-on experience resolving denials in at least two of these specialties: Radiology, Cardiology, Ophthalmology, Pulmonary, Neurology, Vascular, or procedure-based services.
- Strong working knowledge of CARC/RARC denial codes and the correct resolution for each.
- Proven experience writing and submitting appeals and reconsiderations, including multi-level appeals.
- Working knowledge of CPT, ICD-10, and common modifiers (e.g., 25, 26, TC, 59/XS, 24, 79, RT/LT).
- Understanding of prior authorization, medical necessity, global periods, bundling (NCCI edits), timely filing, appeal limits, and COB.
- Ability to read and apply payer medical policies and LCD/NCD guidelines when building an appeal.
- Experience with payer portals (e.g., Availity, payer-specific portals) and payer calling.
- Experience with at least one PM/EMR system.
- Good spoken and written English for payer calls, appeal letters, and claim documentation.
- Accuracy, attention to detail, analytical thinking, and ownership of assigned claims.
Nice to Have
- Experience with New York plans: Empire Plan, Fidelis Care, EmblemHealth, BCBS, NY Medicaid.
- Experience with eClinicalWorks (strong plus).
- Experience with radiology benefit managers and authorization vendors (e.g., eviCore, Carelon).
- Experience with denial tracking, trending, or root-cause categorization.
- Multi-specialty group experience.
- Coding certification (CPC, CCS-P, or similar).
Why Join NPB Health
