Senior Denials & Appeals Specialist

🔥 12 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Baylor Genetics

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1978

🏥 Healthcare

💼 Consulting

🍽️ Food & Beverage

Healthcare • Consulting • Food & Beverage

Baylor Genetics is a clinical genomics and precision diagnostics laboratory affiliated with Baylor College of Medicine that provides comprehensive genetic testing and interpretation services. The company offers whole genome and whole exome sequencing, chromosomal microarray analysis, mitochondrial testing, pharmacogenomics, and specialized assays, along with genetic counseling, provider support, and insurance/payment resources. Baylor Genetics supports healthcare providers, researchers, and families with AI-enhanced interpretation, multimodal data integration, and end-to-end clinical and laboratory services.

📋 Description

• Oversee and manage the appeals process for denied claims, ensuring timely and accurate submission according to payer guidelines • Handle complex or high-value denials and consult with appropriate staff to resolve outstanding issues • Analyze denied claims to identify root causes, trends, and patterns • Collaborate with departments to implement corrective actions and prevent recurrence • Work with billing, coding, payer relations, and clinical teams to address denial-related issues • Provide guidance on coding, documentation, and billing practices • Ensure denials and appeals comply with applicable regulations and guidelines, including HIPAA • Maintain thorough and accurate documentation • Prepare and submit detailed appeal letters and supporting documentation to payers • Provide training and support to junior denials and appeals specialists • Track KPIs including appeal success rates, denial trends, and resolution times • Report findings to senior management

🎯 Requirements

• College degree preferred or equivalent experience of 5 plus years • 5 years’ experience in medical billing • Strong preference for molecular laboratory billing experience • Medical billing experience may be substituted for a bachelor’s degree • Understanding of patient protections under HIPAA and proper handling of protected health information (PHI) • Working knowledge of health insurance and terminology • Excellent communication and people skills • Meticulous with strong analytical and problem-solving abilities • Strong knowledge of insurance guidelines, CPT/ICD-10 codes, and medical terminology • Excellent attention to detail and time management skills • Effective communication and problem-solving abilities • Proficiency in Microsoft Office Suite and healthcare software tools

🏖️ Benefits

• Equal opportunity employer committed to an inclusive and diverse workforce • Full-time remote work arrangement