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Denial Resolution Specialist Jobs (NOW HIRING)

Westerkamp Group

PB Denial Specialist - EPIC

TX · Remote

$19.25 - $24.50/hr

In this crucial role, you will lead a team of denial specialists, driving the resolution of denied claims, identifying root causes, and implementing strategies to prevent future denials. Your dual ...

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Denial Resolution Specialist information

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$28

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How much do denial resolution specialist jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for denial resolution specialist in the United States is $28.72, according to ZipRecruiter salary data. Most workers in this role earn between $18.99 and $36.06 per hour, depending on experience, location, and employer.

What is the difference between Denial Resolution Specialist vs Claims Analyst?

AspectDenial Resolution SpecialistClaims Analyst
CredentialsTypically requires healthcare or insurance-related certificationsOften requires a degree in healthcare, finance, or related fields
Work EnvironmentHealthcare providers, insurance companies, or third-party administratorsInsurance companies, healthcare organizations, or consulting firms
Job FocusInvestigating and resolving denied insurance claimsAnalyzing claims data to improve processing and reduce denials

While both roles involve working with insurance claims, a Denial Resolution Specialist primarily focuses on resolving denied claims by investigating reasons for denial and appealing when necessary. In contrast, a Claims Analyst analyzes claims data to identify trends and improve overall claims processing efficiency. Both roles require knowledge of insurance policies and strong analytical skills, but their day-to-day tasks and objectives differ.

What is a denial resolution specialist?

Denial Resolution Specialists are professionals who work primarily within healthcare organizations to manage and resolve insurance claim denials. Their main responsibilities include reviewing denied claims, identifying the reasons for denial, and working with insurance companies and healthcare providers to appeal and overturn those decisions. They play a critical role in ensuring that healthcare providers receive appropriate reimbursement for services rendered and in minimizing lost revenue. Denial Resolution Specialists must have strong analytical, communication, and problem-solving skills, as well as a thorough understanding of medical billing and insurance regulations.

What skills and qualifications are needed to thrive as a denial resolution specialist?

To thrive as a Denial Resolution Specialist, you need a solid understanding of medical billing, insurance claims processing, and healthcare regulations, often supported by experience in revenue cycle management. Familiarity with billing software, electronic health record (EHR) systems, and industry coding standards such as ICD-10 and CPT is typically required. Strong analytical skills, attention to detail, and effective communication are essential soft skills for investigating claim denials and collaborating with payers and providers. These skills and qualifications are crucial for efficiently resolving denied claims, maximizing reimbursements, and ensuring compliance with regulatory standards.

What are common challenges faced by denial resolution specialists, and how can they be overcome?

Denial Resolution Specialists often encounter challenges such as navigating complex insurance policies, addressing incomplete or inaccurate documentation, and communicating effectively with payers to resolve claim denials. Overcoming these obstacles typically involves staying up-to-date on payer guidelines, fostering strong collaboration with billing and clinical teams, and developing excellent problem-solving and negotiation skills. Building a thorough understanding of claims processes and maintaining attention to detail can significantly improve resolution rates and workflow efficiency in this role.
More about Denial Resolution Specialist jobs
What are the most commonly searched types of Denial Resolution Specialist jobs? The most popular types of Denial Resolution Specialist jobs are:
What job categories do people searching Denial Resolution Specialist jobs look for? The top searched job categories for Denial Resolution Specialist jobs are:
Denial Resolution Specialist jobs near you
Infographic showing various Denial Resolution Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $59,736 per year, or $28.7 per hour.

MSRDP Clinical Denial Management Specialist III - Surgical Billing Follow Up

UT Southwestern Medical Center

Dallas, TX • On-site

$18.50 - $23.75/hr

Full-time

Re-posted 7 days ago

UT Southwestern rating

7.9

Company rating: 7.9 out of 10

Based on 152 frontline employees who took The Breakroom Quiz

108th of 887 rated healthcare providers

Job description

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
Salary
Salary Negotiable
Experience and Education
  • High School diploma or equivalent, Associates degree preferred, and six (6) years medical billing or collections experience. Two (2) years must include denial management and proven knowledge of billing/coding guidelines for complex E&M services, diagnostic studies, and/or minor surgical procedures that encompasses CPT and ICD-10 codes, modifiers, and payer specific rules.
  • Experience involving complex diagnostic studies, endoscopic, interventional and/or surgical procedures preferred.
  • Requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
  • Requires knowledge of CMS 1500, ICD-10, and CPT coding.
  • Requires working knowledge of Epic Resolute.

Job Duties
  • Review, research and resolve coding denials for complex diagnostic studies, endoscopic, interventional and/or major surgical procedures. This includes denials related to the billed E&M, CPT, diagnosis, and modifier. Denial types could include bundling, concurrent care, frequency and limited coverage.
  • Prepare and submit claim appeals, based on payor guidelines, on complex coding denials. Identify denial, payment, and coding trends in an effort to decrease denials and maximize collections.
  • Contact payers, via website, phone and/or correspondence, regarding reimbursement of claims denied for coding related reasons.
  • Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
    Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and paper/fax processes.
  • Requires proven analytical, and decision making skills to determine what selective clinical information must be submitted to properly appeal the denial.
  • Requires proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line.
  • Clear and concise written and oral communication with payors, providers, and billing staff to insure resolution of complex coding denials.
  • Ability to read and interpret E&M notes, complex diagnostic study results, endoscopic and interventional results and/or major surgical operative notes.
  • Based on the documentation review, confirm or change the billed CPT code(s), diagnosis code(s) and modifiers (if applicable) in order to attain denial resolution. Requires proven knowledge of the specialty specific service line documentation requirements.
  • Must be familiar with the Medicare and Medicaid teaching physician documentation billing rules within 60 days of hire.
  • Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical Collectors and MSRDP Clinical Denials Management Specialist I & II.
  • Requires a billing and coding knowledge level that provides guidance on and resolution to resolve claim denials and rejections.
  • Makes necessary adjustments as required by plan reimbursement.
    Duties performed may include one or more of the following core functions: (a) Directly interacting with or caring for patients; (b) Directly interacting with or caring for human-subjects research participants; (c) Regularly maintaining, modifying, releasing or similarly affecting patient records (including patient financial records); or (d) Regularly maintaining, modifying, releasing or similarly affecting human-subjects research records.
  • Perform other duties as assigned.

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

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