Denial Management Specialist

Job Description

Job Description

Job Summary

We are seeking a detail-oriented and analytical Denials & Appeal Management Specialist to join our Revenue Cycle Management (RCM) team. This role is responsible for reviewing denied claims, identifying root causes, and managing the appeals process to ensure maximum reimbursement and compliance with payer guidelines.

Key Responsibilities

· Review and analyze denied or underpaid claims from insurance payers

· Identify trends and root causes of denials and recommend corrective actions

· Prepare and submit timely and accurate appeal letters with supporting documentation

· Follow up with insurance companies to track appeal status and ensure resolution

· Collaborate with billing, coding, and clinical teams to resolve discrepancies

· Maintain detailed records of appeals, communications, and outcomes

· Ensure compliance with payer policies, regulatory requirements, and internal SOPs

· Monitor denial metrics and contribute to performance improvement initiatives

· Stay updated on payer rules, coding changes, and industry best practices

Required Qualifications

· Bachelor’s degree in Healthcare Administration, Life Sciences, or related field (preferred)

· 2–5 years of experience in medical billing, AR follow-up, or denial management

· Strong understanding of insurance claim lifecycle and denial codes

· Knowledge of CPT, ICD-10, and HCPCS coding systems

· Experience with US healthcare payers (Medicare, Medicaid, Commercial)

· Excellent written and verbal communication skills

· Strong analytical and problem-solving abilities

· Proficiency in MS Excel and RCM tools/software

Preferred Skills

· Experience in drafting appeal letters and handling complex denials

· Familiarity with EHR/EMR systems

· Certification such as CPC, CCS, or CRCS is a plus

· Ability to manage high-volume workload and meet deadlines

· Attention to detail with strong organizational skills

Key Performance Indicators (KPIs)

· Appeal success rate / recovery rate

· Reduction in denial percentage

· Turnaround time for appeals submission

· Aging of denied claims

· Accuracy and compliance levels

Company Description

Credence Global Solutions (“CGS”) is a Dallas, Texas based diversified technology driven financial transformation company with deep expertise in receivables management and voice based BPO. With focus on Receivables Management, Healthcare RCM, Technology Platforms and Contact Center verticals, CGS services leading telecommunication, healthcare, and media companies.

Healthcare providers serviced by CGS include medical transport providers, emergency physicians, health infusion service providers and diagnostic laboratories. In the telecommunication vertical, CGS serves four of the top five providers in United States.

Credence Resource Management is the flagship company of the Credence Group.

Our mantra is Excellence Beyond Belief. Challenges, growth opportunities and a passion for the Job enables us to repeatedly deliver excellence to our clients. Our teams are encouraged to continually explore their talents and pursue their interests, giving them the authority to gain knowledge and skills to truly be the expert in their domain. We strive to bring on the best and brightest, as well as to invest in their training and education, making them a seamless extension of your team.

Headquartered in Dallas TX, we have delivery offices in San Jose CA; Natchez MS; Mesa AZ & Pune India. Visit to know more about the company.

Company Description

Credence Global Solutions (“CGS”) is a Dallas, Texas based diversified technology driven financial transformation company with deep expertise in receivables management and voice based BPO. With focus on Receivables Management, Healthcare RCM, Technology Platforms and Contact Center verticals, CGS services leading telecommunication, healthcare, and media companies.\r\n\r\nHealthcare providers serviced by CGS include medical transport providers, emergency physicians, health infusion service providers and diagnostic laboratories. In the telecommunication vertical, CGS serves four of the top five providers in United States.\r\n\r\nCredence Resource Management is the flagship company of the Credence Group.\r\n\r\nOur mantra is Excellence Beyond Belief. Challenges, growth opportunities and a passion for the Job enables us to repeatedly deliver excellence to our clients. Our teams are encouraged to continually explore their talents and pursue their interests, giving them the authority to gain knowledge and skills to truly be the expert in their domain. We strive to bring on the best and brightest, as well as to invest in their training and education, making them a seamless extension of your team.\r\n\r\nHeadquartered in Dallas TX, we have delivery offices in San Jose CA; Natchez MS; Mesa AZ & Pune India. Visit to know more about the company.