Firstsource
Clinical Denials Specialist
Remote, Remo · Remote · Full-time · Posted Oct 6, 2026
- Education
- Associate degree in a business or healthcare-related field is recommended.
About the job
Manages clinical claim denials by reviewing cases, recommending next steps, writing and submitting appeals, and tracking outcomes and trends.
What you'll do
- Research payer denials and review utilization and coverage guidelines.
- Prepare and submit appeal letters grounded in clinical documentation, payer policies, and contract language.
- Track denial and appeal outcomes, report trends, and identify process improvements.
What they ask for
- Professional written and verbal communication skills.
- Proficient PC skills and ability to type 30–40 wpm.
- Ability to prioritize multiple tasks and work with little or no supervision.
- Maintain confidentiality and comply with applicable regulations, including HIPAA.
Nice to have
- Associate degree in a business- or healthcare-related field.
- RN certification with care management, utilization review, prior authorization, and appeals experience; EHR experience with Epic, Cerner, or Meditech is also recommended.
Tools
Epic, Cerner, Meditech
Model-written summary · the original posting is authoritative