Senior Denials & Appeals Strategist

Baylor Miraca Genetics Laboratories LLC; United States; On-site; USD 75,000 - 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 to ensure accurate reimbursement and minimize revenue loss.

You will analyze denied claims, identify trends, and collaborate with billing, coding, and customer service to optimize the revenue cycle. The role requires strong knowledge of payer guidelines, healthcare billing codes, and HIPAA compliance.

Qualifications

• 5+ years of medical billing experience; degree optional.
• HIPAA and PHI handling knowledge required.
• Understanding of health insurance terminology and payer requirements.

Responsibilities

• Oversee the appeals process for denied claims and ensure timely submissions.
• Analyze denied claims to identify root causes and trends.
• Collaborate with billing, coding, payer relations, and clinical teams to resolve issues.
• Ensure denial and appeal documentation complies with regulations and guidelines.
• Prepare and submit appeal letters and supporting documentation to payers.
• Provide training to junior staff on best practices and payer requirements.
• Track KPIs on appeal success, denial trends, and resolution times.

Skills

Insurance guidelines

CPT/ICD-10

Medical terminology

Attention to detail

Time management

Communication

Problem-solving

Education

Bachelor's degree preferred

5+ years medical billing experience

Tools

Microsoft Office Suite

Healthcare software tools

Job description

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

You will analyze denied claims, identify trends, and collaborate with billing, coding, and customer service to optimize the revenue cycle. The role requires strong knowledge of payer guidelines, healthcare billing codes, and HIPAA compliance.