Outpatient Denials & Appeals Specialist

Capital Health (US); New York (NY); On-site; USD 28,000 - 36,000; Full time

Benefits offered by this job

Medical Plan

Prescription drug coverage & In-House

Dental Plan

Vision Plan

Flexible Spending Account (FSA)

Healthcare FSA

Dependent Care FSA

Retirement Savings and Investment Plan

Basic Group Term Life and AD&D

Paid Time-Off Program

Job summary

Capital Health is seeking an experienced outpatient denials coordinator to manage triage, documentation, and appeals in collaboration with Clinical Appeals RN and authorization teams. The role focuses on ensuring timely resolution and denial prevention across payer policies.

You will maintain accurate denial inventories, coordinate medical record requests, and document outcomes in the billing system. The position supports Revenue Integrity and requires strong organizational skills, attention to

Qualifications

• High school diploma or equivalent required; associate or bachelor's in healthcare or business preferred.
• Three years’ hospital billing, denials management, utilization review support, or related revenue cycle experience.
• Experience with outpatient clinical denials or medical necessity line-item denials preferred.
• Knowledge of outpatient clinical denial categories, including payer medical policy, experimental/investigational, and clinical criteria denials.
• Familiarity with payer authorization processes and outpatient clinical documentation workflows.
• Ability to track, document, and manage inventory across multiple appeal levels.
• Strong organizational skills and attention to detail.
• Ability to identify root causes and recurring outpatient denial drivers.
• Strong written communication for documentation and coordination.
• Proficiency with hospital billing systems, EMR navigation, and payer portals.

Responsibilities

• Review and triage outpatient clinical denials, including medical policy, experimental/investigational, and clinical criteria denials.
• Route cases to appropriate clinical resources based on denial type and appeal viability.
• Maintain accurate denial inventories with deadlines, levels, and outcomes.
• Coordinate medical record requests, appeal packet preparation, and submission tracking.
• Ensure compliance with payer requirements and timelines for outpatient denials.
• Perform payer follow-up activities via portal research and phone outreach.
• Document clear notes in the billing system related to denial actions and status.
• Identify recurring denial trends and escalate to leadership.
• Support denial prevention initiatives with providers, authorization teams, Revenue Integrity, and operations.
• Maintain knowledge of payer policies and appeal processes.

Skills

Denials management

Revenue cycle

EMR navigation

Payer portals

Hospital billing

Analytical skills

Written communication

Education

High school diploma

Associate or bachelor’s degree in healthcare or business

Tools

Hospital billing systems

EMR systems

Payer portals

Job description

Capital Health is seeking an experienced outpatient denials coordinator to manage triage, documentation, and appeals in collaboration with Clinical Appeals RN and authorization teams. The role focuses on ensuring timely resolution and denial prevention across payer policies.

You will maintain accurate denial inventories, coordinate medical record requests, and document outcomes in the billing system. The position supports Revenue Integrity and requires strong organizational skills, attention to