Denials Management Specialist

Delta Health is seeking a Denials Management Specialist to identify, analyze, and resolve insurance claim denials while helping prevent future revenue loss. This role works closely with clinical, coding, billing, and admissions teams to improve reimbursement accuracy and overall revenue cycle performance. Key Responsibilities Review and resolve insurance denials across Medicare, Medicaid, Managed Care, Commercial, and Self-Pay payers Research denied claims using medical records, coding guidelines, payer contracts, and coverage policies Submit appeals, reconsiderations, and corrected claims within filing deadlines Prepare appeal letters citing CMS regulations, payer policies, and contract language Track appeal outcomes, follow up on underpayments, and escalate when needed Identify denial trends and perform root-cause analysis. Provide feedback and education to reduce preventable denials. Maintain denial logs, monitor KPIs, and prepare summary reports Ensure compliance with CMS, Medicaid, payer regulations, HIPAA, and organizational policies Required Qualifications High school diploma or equivalent (associate degree preferred) 2-5 years of healthcare revenue cycle experience focused on denials or appeals Strong knowledge of medical terminology, CPT, HCPCS, ICD-CM/PCS, EOBs, ERAs, and CAS codes Experience with hospital or professional billing systems and payer portals Preferred Qualifications Experience in hospital, rural hospital, CAH, RHC, or multi-specialty clinic settings Knowledge of Medicare, Medicaid (including out-of-state), and managed care rules CPC, CRCS, or similar certification preferred Why Join Delta Health? Comprehensive Benefits Package Medical, RX, Dental & Vision - Low premiums with 100% coverage on services provided within the Delta Health system, and no deductibles or co-pays. Includes access to massage therapy, acupuncture, and chiropractic care . Life & Disability Insurance - Employer-paid coverage for your peace of mind. Time Off - Over 4 weeks of paid vacation annually (including sick and personal leave) for full-time staff. Retirement - 403(b) plan with up to a 3% employer match . Work-Life Balance in a Stunning Location Located on the Western Slope of the Rocky Mountains, Delta offers an unmatched combination of small-town charm, affordability, and natural beauty. Enjoy year-round outdoor activities such as hiking, skiing, mountain biking, fishing, and exploring the Grand Mesa and surrounding public lands. Whether you're raising a family or looking for work-life balance, Delta provides a safe, friendly community with a slower pace and a high quality of life. Delta is surrounded by the Grand Mesa, Uncompahgre Plateau, and nearby wineries, offering a unique blend of adventure and relaxation. Delta Health is a county-wide healthcare system with more than 100 years of dedication to serving our community. Our 49-bed hospital and outpatient locations across Delta County are committed providing remarkable care in a healing environment . We operate with the core belief: Excellence. Every Patient. Every Time . We are an equal opportunity employer . All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity or expression, age, national origin, disability, veteran status, or any other protected characteristic.