About the denial management role
A denial is evidence of an upstream mistake: coverage that wasn't checked, an authorization that lapsed, a modifier that was missing, a diagnosis that didn't support the service. Working the claim gets this payment in; fixing the cause stops the next hundred denials. As a denial management specialist you do both.
You will work denials daily across several outpatient practices, appeal what is worth appealing inside each payer's deadline, and keep a running record of root causes that the account lead reviews with the practice every month.
What you will do
- Triage new denials daily by CARC/RARC code, payer, dollar value and appeal deadline
- Correct and resubmit claims for front-end and coding errors
- Write first- and second-level appeals with supporting records and payer policy citations
- Request peer-to-peer reviews or retro-authorizations where the payer allows them
- Categorise each denial by root cause and the stage of the cycle that produced it
- Prepare a monthly denial summary by payer and reason for the account lead
- Work with front-desk, coding and credentialing teams to fix recurring causes
What you need
- Two or more years working medical claim denials and appeals
- Fluency with CARC and RARC codes and how payers apply them
- Experience with medical necessity, authorization, eligibility, bundling and timely filing denials
- Strong written English — appeals are persuasive documents
- An analytical streak: you want to know why it keeps happening
Helpful, not required
A coding credential (CPC or CPB), Medicare redetermination and reconsideration experience, and familiarity with payer medical policies and LCDs.
Working remotely at CredSpun
This is a fully remote, work-from-home role open to applicants living in the United States. You work during U.S. business hours alongside a named account team, inside each client practice's own EHR and practice management system, with every login tied to you personally. You need a quiet, private workspace, a reliable broadband connection and a computer that can run a current browser and a second monitor. HIPAA training is part of onboarding, and you sign our confidentiality terms before you are given access to any patient data.