Revenue Recovery: Denial Resolution Specialist

Western Missouri Medical Center; Warrensburg (MO); On-site; USD 65,000 - 85,000; Full time

Job summary

Western Missouri Medical Center in Warrensburg, MO is seeking a Denial Resolution Specialist to review, resolve, and prevent denied claims, maximizing reimbursement and reducing revenue leakage. You will analyze EOBs/ERAs, manage denial queues, and coordinate appeals with payers to improve denial rates.

The role requires healthcare billing experience, MEDITECH familiarity, and strong analytical, communication, and problem-solving skills to drive revenue integrity and compliance.

Qualifications

• High school diploma or equivalent required.
• Bachelor's degree preferred.
• Residency in KS or MO required.
• 3+ years healthcare billing or revenue cycle experience.
• Experience with MEDITECH and SSI Clearinghouse.
• Understanding of insurance billing lifecycle and denial codes.
• Experience in denial management or appeals.
• Analytical and critical thinking skills.
• Strong attention to detail and problem-solving abilities.
• Effective communication and negotiation skills.

Responsibilities

• Review denied claims in MEDITECH denial work queues (DEN-*).
• Analyze EOB/ERA and payer codes (CARC/RARC).
• Correct and resubmit claims as needed.
• Submit reconsiderations or formal appeals.
• Request additional documentation when needed.
• Ensure denials are worked within SLA (≈5 days).
• Prepare and submit initial and secondary appeals.
• Gather medical records, coding docs, and authorization details.
• Track appeal status and escalate high-dollar cases.
• Maintain and prioritize denial queues to prevent backlog.
• Communicate with payers to clarify denial reasons and appeal requirements.
• Document all actions accurately and maintain compliance with CMS and payer requirements.

Skills

Analytical thinking

Attention to detail

Problem solving

Communication

Deadline management

Education

High school diploma or equivalent

Bachelor's degree preferred

Tools

MEDITECH

SSI Clearinghouse

Job description

Western Missouri Medical Center in Warrensburg, MO is seeking a Denial Resolution Specialist to review, resolve, and prevent denied claims, maximizing reimbursement and reducing revenue leakage. You will analyze EOBs/ERAs, manage denial queues, and coordinate appeals with payers to improve denial rates.

The role requires healthcare billing experience, MEDITECH familiarity, and strong analytical, communication, and problem-solving skills to drive revenue integrity and compliance.