Senior Denials & Appeals Strategist

Baylor Genetics; United States; On-site; USD 70,000 - 110,000; Full time

Job summary

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

The role requires deep knowledge of payer guidelines, CPT/ICD-10 coding, and HIPAA compliance, with collaboration across billing, coding, payer relations, and clinical teams to optimize the revenue cycle. Strong analytic skills and proactive problem-solving are essential to identify trends and

Qualifications

• College degree preferred or equivalent experience of 5 plus years.
• 5 years’ experience in medical billing; strong preference will be given to candidates with molecular laboratory billing experience. Medical billing experience may be substituted for a bachelor’s degree.
• Understanding of patient protections under HIPAA and proper handling of protected health information (PHI).
• Working knowledge of health insurance and terminology.
• Excellent communication and people skills.
• Meticulous with strong analytical and problem-solving abilities.

Responsibilities

• Oversee and manage the appeals process for denied claims, ensuring timely and accurate submission of appeal documentation according to payer guidelines. Handle complex or high-value denials, consulting with appropriate staff to resolve outstanding issues.
• Analyze denied claims to identify root causes, trends, and patterns. Work collaboratively with departments to implement corrective actions and prevent recurrence.
• Work closely with billing, coding, payer relations, and clinical teams to address issues related to denials. Provide guidance on proper coding, documentation, and billing practices.
• Ensure that all denials and appeals are handled in compliance with applicable regulations and guidelines (e.g., HIPAA), and maintain thorough and accurate documentation.
• Prepare and submit detailed and timely appeal letters and supporting documentation to payers, following specific payer requirements.
• Provide training and support to junior denials and appeals specialists on best practices, guidelines, and payer requirements. Foster a collaborative work environment.
• Track key performance indicators (KPIs) related to the denials and appeals process, including appeal success rates, denial trends, and resolution times. Report findings to senior management.

Skills

Insurance guidelines CPT/ICD-10

Communication skills

Analytical thinking

Microsoft Office Suite

Healthcare software tools

Education

Bachelor's degree or equivalent experience

Job description

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

The role requires deep knowledge of payer guidelines, CPT/ICD-10 coding, and HIPAA compliance, with collaboration across billing, coding, payer relations, and clinical teams to optimize the revenue cycle. Strong analytic skills and proactive problem-solving are essential to identify trends and