Denials & Appeals Billing Specialist

DHR Health; Edinburg (TX); On-site; USD 40,000 - 54,000; Full time

Job summary

DHR Health is seeking a Billing and Collections Specialist I for the Denials Management team in Edinburg, TX. This role focuses on reviewing denied claims, drafting appeals with clinical indicators, and reporting on quality metrics within Revenue Cycle.

The position requires a high school diploma, 0–2 years in healthcare, and knowledge of CPT/HCPCS/ICD-10. Bilingual English/Spanish is preferred; strong Excel and MS Office skills are beneficial.

Qualifications

• High School Diploma/GED is required.
• 0-2 years of experience in a healthcare setting.
• Experience in healthcare billing and reimbursement.
• Experience with EMR system workflows.
• Strong knowledge of health care services reimbursement methodologies.
• Knowledge of claim forms and remittance advice, including coding and billing practices.
• Ability to interpret contract language.
• Working knowledge of medical terminology.

Responsibilities

• Advocate for the facility’s mission, vision, and values by effectively communicating them and incorporating them into service development, standards, and practices.
• Demonstrate ability in handling denials and appeals.
• Draft detailed appeal letters with all necessary information.
• Manage and follow up on assigned insurance accounts
• Follow payer billing and collection rules as outlined in payer manuals when interacting with insurance carriers.
• Utilize different software systems to verify eligibility and claim status
• Demonstrate proficiency in billing and following up on claims using online or billing software.
• Access payer websites as needed to retrieve information.

Skills

Denials management

Appeals drafting

Customer service

Healthcare billing

Microsoft Office

Excel

Bilingual - English/Spanish

Contract interpretation

Education

High School Diploma/GED

Tools

EMR system workflows

Job description

DHR Health is seeking a Billing and Collections Specialist I for the Denials Management team in Edinburg, TX. This role focuses on reviewing denied claims, drafting appeals with clinical indicators, and reporting on quality metrics within Revenue Cycle.

The position requires a high school diploma, 0–2 years in healthcare, and knowledge of CPT/HCPCS/ICD-10. Bilingual English/Spanish is preferred; strong Excel and MS Office skills are beneficial.