Claims Denials & Appeals Specialist – Hospital Revenue Cycle

The Staff Pad; Ohio; Sur place; USD 55 000 - 75 000; Plein temps

Résumé du poste

The Staff Pad partners with a reputed healthcare organization in Hamilton, TX and we are seeking a detail-oriented Claims Denials & Appeals Specialist to support revenue cycle operations.

This full-time role focuses on resolving claim denials, managing appeals, identifying reimbursement discrepancies, and helping improve claims processes to support timely and accurate payments. The position requires 1+ year of hospital revenue cycle experience, with 2+ years preferred.

Qualifications

• High school diploma or equivalent required.
• Associate degree or coursework in healthcare administration, business, medical billing or related field preferred.
• 1+ year of hospital revenue cycle experience involving denials, appeals, or insurance follow-up required.
• 2+ years of relevant experience preferred.
• Knowledge of hospital billing, payer requirements, EOBs, remittance advice, claim adjustment codes, and appeals processes.
• Relevant revenue cycle or billing certification preferred.

Responsabilités

• Review, resolve, and track assigned claim denials and appeals.
• Identify recurring denial trends and support prevention efforts.
• Review payment discrepancies against payer contracts and reimbursement guidelines.
• Follow up on underpayments and pursue appropriate reimbursement recovery.
• Communicate unresolved payment issues and trends to leadership.
• Maintain accurate work queues, documentation, and reports to support reimbursement, timely filing, and departmental improvement.
• Manage assigned inpatient, outpatient, ED, surgery, swing bed, rural health clinic, and professional claims across commercial and government payers.
• Coordinate with clinical and administrative teams to support timely claim resolution and reimbursement.
• Manage assigned payer and service responsibilities, including non-traditional Medicare appeals, clinical appeals, payment variances, and discharged-not-final-billed (DNFB) follow-up.

Connaissances

Analytical skills

Organizational skills

Documentation skills

Communication skills

Attention to detail

Formation

High school diploma

Associate degree or coursework in healthcare administration, business, medical billing

Outils

Excel

EHR systems

Clearinghouse queues

Payer portals

Description du poste

Claims Denials & Appeals Specialist – Hospital Revenue Cycle

Hamilton, United States | Posted on 11/11/2026

• Work Experience 1+ Year Hospital Revenue Cycle Experience Required, 2+ Years Relevant Experience Preferred
• City Hamilton
• State/Province Texas
• Country United States

Job Description

The Staff Pad is proud to partner with a reputed healthcare organization in Hamilton, TX and we are seeking a detail-oriented Claims Denials & Appeals Specialist to support revenue cycle operations.

This role focuses on resolving claim denials, managing appeals, identifying reimbursement discrepancies, and helping improve claims processes to support timely and accurate payments

Schedule: Full-Time

What You’ll Do

Key responsibilities

• Review, resolve, and track assigned claim denials and appeals
  
• Identify recurring denial trends and support prevention efforts
  
• Review payment discrepancies against payer contracts and reimbursement guidelines
  
• Follow up on underpayments and pursue appropriate reimbursement recovery
  
• Communicate unresolved payment issues and trends to leadership
  
• Maintain accurate work queues, documentation, and reports to support reimbursement,
  
• timely filing, and departmental improvement
  
• Manage assigned inpatient, outpatient, emergency department, surgery, swing bed, rural health clinic, and professional claims across commercial and government payers
  
• Coordinate with clinical and administrative teams to support timely claim resolution and reimbursement
  
• Manage assigned payer and service responsibilities, including non-traditional Medicare appeals, clinical appeals, payment variances, and discharged-not-final-billed (DNFB) follow-up, based on departmental assignments
  

What We Are Looking For

Education, Experience and Certifications

• High school diploma or equivalent required
  
• Associate degree or coursework in healthcare administration, business, medical billing, or a related field preferred
  
• 1+ year of hospital revenue cycle experience involving denials, appeals, or insurance follow-up required
  
• 2+ years of relevant experience preferred
  
• Critical access hospital and rural health clinic billing experience preferred
  
• Knowledge of hospital billing, payer requirements, EOBs, electronic remittance advice, claim adjustment codes, and appeals processes
  
• Relevant revenue cycle or billing certification preferred
  

Additional Skills and Attributes

• Proficiency in Excel, electronic health records, clearinghouse work queues, and payer portals
  
• Strong analytical, organizational, documentation, and communication skills
  
• Ability to manage multiple deadlines, analyze detailed information, and exercise sound judgment
  
• Ability to perform intermittent walking, sitting, and standing, with occasional bending, reaching, and lifting up to 20 pounds
  

Reasonable accommodations may be provided to support essential job functions

What You Can Expect

• Paid Time Off & Holidays
  
• Health & Supplemental Insurance
  
• Direct Deposit & Education Reimbursement
  
• Fitness Center Membership
  
• Retirement Plan
  

If you are detail-oriented, analytical, and experienced in healthcare revenue cycle operations, this is an opportunity to apply your expertise in claims resolution, appeals management, and reimbursement recovery while supporting the financial efficiency of a healthcare organization.