Senior Denials & Appeals Strategist

Baylor Genetics; Northern (KY); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Baylor Genetics is seeking a Sr. Denials & Appeals Specialist to manage complex insurance denials and oversee the appeals process, ensuring accurate reimbursement and minimizing revenue loss.

The role requires analyzing denied claims, identifying trends, and developing strategies to prevent future denials while aligning with payer guidelines. You will collaborate with billing, coding, payer relations, and clinical teams to address issues, maintain HIPAA-compliant documentation, and prepare

Qualifications

• 5+ years of medical billing experience, with preference for molecular lab billing.
• HIPAA and PHI handling knowledge.
• Strong understanding of health insurance and terminology.
• Excellent communication and people skills.
• Meticulous with strong analytical and problem-solving abilities.

Responsibilities

• Oversee the appeals process for denied claims, ensuring timely submission of appeal documentation per payer guidelines.
• Analyze denied claims to identify root causes, trends, and patterns; implement corrective actions.
• Collaborate with billing, coding, payer relations, and clinical teams to address denial-related issues.
• Ensure all denials and appeals comply with HIPAA and maintain thorough documentation.
• Prepare and submit detailed appeal letters and supporting documentation to payers per requirements.
• Train and support junior denials and appeals specialists on best practices and payer requirements.
• Track KPIs related to denials and appeals (e.g., appeal success rates, resolution times) and report to management.

Skills

Insurance guidelines

CPT/ICD-10 codes

Medical terminology

Attention to detail

Communication skills

Problem solving

Education

Bachelor's degree or equivalent experience

Tools

Microsoft Office Suite

Healthcare software

Job description

Baylor Genetics is seeking a Sr. Denials & Appeals Specialist to manage complex insurance denials and oversee the appeals process, ensuring accurate reimbursement and minimizing revenue loss.

The role requires analyzing denied claims, identifying trends, and developing strategies to prevent future denials while aligning with payer guidelines. You will collaborate with billing, coding, payer relations, and clinical teams to address issues, maintain HIPAA-compliant documentation, and prepare