Claims Denials & Appeals Specialist – Hospital Revenue Cycle

The Staff Pad is proud to partner with a reputed healthcare organization in Hamilton, TX and we are seeking a detail-oriented Claims Denials & Appeals Specialist to support revenue cycle operations. This role focuses on resolving claim denials, managing appeals, identifying reimbursement discrepancies, and helping improve claims processes to support timely and accurate payments Schedule: Full-Time What You’ll Do Key responsibilities Review, resolve, and track assigned claim denials and appeals Identify recurring denial trends and support prevention efforts Review payment discrepancies against payer contracts and reimbursement guidelines Follow up on underpayments and pursue appropriate reimbursement recovery Communicate unresolved payment issues and trends to leadership Maintain accurate work queues, documentation, and reports to support reimbursement, timely filing, and departmental improvement Manage assigned inpatient, outpatient, emergency department, surgery, swing bed, rural health clinic, and professional claims across commercial and government payers Coordinate with clinical and administrative teams to support timely claim resolution and reimbursement Manage assigned payer and service responsibilities, including non-traditional Medicare appeals, clinical appeals, payment variances, and discharged-not-final-billed (DNFB) follow-up, based on departmental assignments What We Are Looking For Education, Experience and Certifications High school diploma or equivalent required Associate degree or coursework in healthcare administration, business, medical billing, or a related field preferred 1+ year of hospital revenue cycle experience involving denials, appeals, or insurance follow-up required 2+ years of relevant experience preferred Critical access hospital and rural health clinic billing experience preferred Knowledge of hospital billing, payer requirements, EOBs, electronic remittance advice, claim adjustment codes, and appeals processes Relevant revenue cycle or billing certification preferred Additional Skills and Attributes Proficiency in Excel, electronic health records, clearinghouse work queues, and payer portals Strong analytical, organizational, documentation, and communication skills Ability to manage multiple deadlines, analyze detailed information, and exercise sound judgment Ability to perform intermittent walking, sitting, and standing, with occasional bending, reaching, and lifting up to 20 pounds Reasonable accommodations may be provided to support essential job functions What You Can Expect Benefits Paid Time Off & Holidays Health & Supplemental Insurance Direct Deposit & Education Reimbursement Fitness Center Membership Retirement Plan If you are detail-oriented, analytical, and experienced in healthcare revenue cycle operations, this is an opportunity to apply your expertise in claims resolution, appeals management, and reimbursement recovery while supporting the financial efficiency of a healthcare organization.