Clinical Denials and Appeals Specialist

We are seeking an experienced Clinical Denials and Appeals Specialist to join our Denials Management team. This role is responsible for reviewing complex payer denials and developing high-quality, evidence-based appeal letters that maximize reimbursement recovery for our healthcare clients. The ideal candidate is a strong clinical reviewer and exceptional writer who can analyze medical records, identify weaknesses in payer determinations, and craft persuasive appeals supported by clinical documentation, regulatory guidance, and payer-specific requirements. The majority of this role is dedicated to appeal generation, appeal strategy, and overturning clinical denials. Key Responsibilities Appeal Development and Submission Generate comprehensive first-level, second-level, and escalated appeal letters for denied claims. Develop compelling clinical arguments using medical records, physician documentation, industry standards, and payer policies. Create appeal packages with all required supporting documentation and submit within payer timelines. Track appeal status, deadlines, and outcomes to ensure timely follow-up. Review and revise appeal content to improve quality, consistency, and overturn success rates. Clinical Denial Analysis Review and assess denials related to: Medical necessity Level of care Clinical validation Authorization issues Audit findings Conduct detailed chart rev...