Denial Specialist

About the role

Reports to: Director of Accounts Receivable. Employment Type: Full-Time; Non-Exempt. Location: Chicago, IL. Work Type: On-Site. Department: Accounting. The Denial Specialist supports Vivia Health’s mission, patient-relations philosophy, and financial sustainability by researching, resolving, and helping prevent denied, rejected, or underpaid healthcare claims. This role reviews payer responses and account documentation, identifies denial root causes, prepares accurate corrections, reconsiderations, and appeals, follows payer and regulatory requirements, documents actions in approved systems, and collaborates with clinical, coding, billing, registration, authorization, and finance partners. The position requires strong attention to detail, timely follow-through, professional communication, billing integrity, and careful protection of patient information. The Denial Specialist is expected to work onsite during scheduled work hours, use approved organizational systems, and maintain auditable documentation that supports timely reimbursement and compliance. This is primarily an onsite, computer- and telephone-based role. The employee regularly communicates, reads detailed information on screens and documents, enters data, and remains in a stationary position for portions of the workday, with the ability to change position as needed. The employee may occasionally move records or office materials weighing up to 20 pounds. The employee must maintain a secure workspace, use approved technology, safeguard Vivia Health equipment and confidential information, and promptly report work-related injuries, privacy issues, security concerns, or safety concerns. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Responsibilities

• Review assigned denied, rejected, or underpaid claims and related remittance information to determine the denial reason, payer requirement, and next appropriate action.
• Validate relevant claim, eligibility, authorization, coding, documentation, registration, billing, and payer information before preparing corrections or appeals.
• Prepare and submit accurate claim corrections, reconsiderations, and appeals with required supporting documentation, using approved channels and within applicable deadlines.
• Prioritize assigned accounts based on filing or appeal deadlines, account value, aging, organizational policy, and manager direction.
• Contact payers and internal partners to obtain claim status, clarify requirements, resolve barriers, and confirm next steps.
• Route matters requiring licensed clinical judgment, coding authority, or