AR Recovery/Healthcare Denials Specialist (On-site Plano, TX)

About the role

Are you an expert in healthcare insurance reimbursement? Do you thrive on solving complex insurance denials and underpayments? Join our team and play a vital role in ensuring hospitals receive the reimbursements they deserve. We’re looking for an experienced Healthcare Denials Specialist to analyze and resolve payer denials and underpayments. You'll be part of a dynamic team using cutting-edge ARO software to streamline medical claims and collections. As a Denials Specialist II, you will also have the opportunity to mentor junior representatives.

Responsibilities

• Investigate and resolve insurance denials and underpayments
• Call healthcare insurance companies, affiliates, and providers to resolve underpayment or denial issues
• Analyze contracts, billing, and collections to ensure accurate reimbursement
• Work closely with leadership and team members to identify denial trends and process improvements
• Create appeals, patient correspondences, and payer communication to support claim resolutions
• Maintain HIPAA compliance and accurately document all work performed

Requirements

• 3+ years of proven success with healthcare insurance billing, follow-up, reimbursement and collections in a hospital or BPO vendor environment
• Deep knowledge of payer rules, including how to interpret denial reasons and submit appeals
• Ability to identify and resolve complex denials and underpayment issues
• Excellent communication skills both written and verbal
• Strong problem-solving and analytical skills to assess insurance payment discrepancies

Qualifications

• Medicaid, Medicare, and Commercial billing experience
• Associate or Bachelor’s degree

Skills

• Experience with healthcare billing/EHR systems (EPIC, Paragon, Zirmed, or similar)
• Strong understanding of medical terminology including claim types (UB-04), CPT, ICD, DRG codes, and EOB/RA
• Proficiency in Microsoft Excel and Word