Denials & Appeals Specialist
Evolving Solution Services, Dallas, TX, United States
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Denials & Appeals Specialist Full Time Dallas, TX, US
6 days ago Requisition ID: 1259
Salary Range: $55,000.00 To $65,000.00 Annually
Location -
Mesquite
Join our team!
Are you looking for an opportunity to serve a bigger purpose with a growing organization? Are you passionate and dedicated to making a positive impact? Then we have a spot waiting for you. We are seeking an engaging Denial and Appeal Specialist to join our growing team in Mesquite. As part of the HHM team, you would be responsible for reviewing, analyzing, and resolving denied healthcare claims by preparing and submitting appeals to insurance companies. This role ensures proper reimbursement by identifying root causes of denials and working closely with billing, coding, and clinical teams.
Responsibilities
Review and analyze denied insurance claims across all payer types (Medicaid, MCO’s, Medicare, Commercial etc.)
Perform detailed denial analysis to determine root cause (coding, documentation, eligibility, authorization, billing errors, payer issues)
Prepare and submit accurate and timely appeal requests with supporting documentation
Own assigned denial inventory and ensure timely resolution
Follow up with insurance companies on appeal status and resolution
Collaborate with providers, coders, and billing teams to gather required information
Track and document all appeals, outcomes, and correspondence
Identify denial trends and recommend process improvements to reduce future denials
Ensure compliance with payer policies, coding standards, and HIPAA regulations
Develop workflows and improve denial management processes
Qualifications To be a productive member of our team, you will have a pleasant and professional demeanor, be a self-starter, have the ability to work independently, strong communication skills and the ability to preserve confidentiality. You will also have the following:
High school diploma or equivalent (Associate’s or bachelor’s preferred)
3-5 years of related experience, prior experience in a revenue cycle with a community-based setting with focus on denials and appeals
Experience in medical billing, coding, or revenue cycle management along with experience with Medicaid, Medicare, and commercial payers
CPC or CPB is a plus
Knowledge of CPT, ICD-10, and HCPCS coding systems
Familiarity with insurance payer policies and claims processes
Experience with EMR/EHR and billing software
Bilingual (English/Spanish) a plus
Benefits
Health Savings Account
403(b) retirement savings plan with dollar-for-dollar matching up to 3% and match 50% of the next 2% (contribute 5% to get 4% matched). 100% vested upon enrollment.
Generous paid time off plan for full-time employees (includes Sick and Volunteer Days)
Paid Holidays
Accidental Death & Dismemberments (ADD) plan
Short-term & Long-term Disability
Employee Assistance Programs (EAP)
HHM CARES Fund (employee emergency relief fund)
Equal Opportunity Employer
HHM Health is committed to providing equal employment opportunity to all individuals regardless of their race, color, religion, gender identity and expression, age, sexual orientation, national origin, disability, veteran status, marital status or any other characteristic protected by federal, state or local law. HHM Health hires and promotes based solely on the qualifications of the individual and the essential functions of the job being filled.
Monday through Friday - 8 am to 5 pm (1 hr lunch)
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Denials & Appeals Specialist Full Time Dallas, TX, US
6 days ago Requisition ID: 1259
Salary Range: $55,000.00 To $65,000.00 Annually
Location -
Mesquite
Join our team!
Are you looking for an opportunity to serve a bigger purpose with a growing organization? Are you passionate and dedicated to making a positive impact? Then we have a spot waiting for you. We are seeking an engaging Denial and Appeal Specialist to join our growing team in Mesquite. As part of the HHM team, you would be responsible for reviewing, analyzing, and resolving denied healthcare claims by preparing and submitting appeals to insurance companies. This role ensures proper reimbursement by identifying root causes of denials and working closely with billing, coding, and clinical teams.
Responsibilities
Review and analyze denied insurance claims across all payer types (Medicaid, MCO’s, Medicare, Commercial etc.)
Perform detailed denial analysis to determine root cause (coding, documentation, eligibility, authorization, billing errors, payer issues)
Prepare and submit accurate and timely appeal requests with supporting documentation
Own assigned denial inventory and ensure timely resolution
Follow up with insurance companies on appeal status and resolution
Collaborate with providers, coders, and billing teams to gather required information
Track and document all appeals, outcomes, and correspondence
Identify denial trends and recommend process improvements to reduce future denials
Ensure compliance with payer policies, coding standards, and HIPAA regulations
Develop workflows and improve denial management processes
Qualifications To be a productive member of our team, you will have a pleasant and professional demeanor, be a self-starter, have the ability to work independently, strong communication skills and the ability to preserve confidentiality. You will also have the following:
High school diploma or equivalent (Associate’s or bachelor’s preferred)
3-5 years of related experience, prior experience in a revenue cycle with a community-based setting with focus on denials and appeals
Experience in medical billing, coding, or revenue cycle management along with experience with Medicaid, Medicare, and commercial payers
CPC or CPB is a plus
Knowledge of CPT, ICD-10, and HCPCS coding systems
Familiarity with insurance payer policies and claims processes
Experience with EMR/EHR and billing software
Bilingual (English/Spanish) a plus
Benefits
Health Savings Account
403(b) retirement savings plan with dollar-for-dollar matching up to 3% and match 50% of the next 2% (contribute 5% to get 4% matched). 100% vested upon enrollment.
Generous paid time off plan for full-time employees (includes Sick and Volunteer Days)
Paid Holidays
Accidental Death & Dismemberments (ADD) plan
Short-term & Long-term Disability
Employee Assistance Programs (EAP)
HHM CARES Fund (employee emergency relief fund)
Equal Opportunity Employer
HHM Health is committed to providing equal employment opportunity to all individuals regardless of their race, color, religion, gender identity and expression, age, sexual orientation, national origin, disability, veteran status, marital status or any other characteristic protected by federal, state or local law. HHM Health hires and promotes based solely on the qualifications of the individual and the essential functions of the job being filled.
Monday through Friday - 8 am to 5 pm (1 hr lunch)
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