RCM Denials Specialist (Denial Recovery)

Job Description Job Summary Insight Global is seeking a fully remote Denials Specialist for our client specializing in orthopedic denials recovery. The RCM Denials Specialist is responsible for recovering revenue lost to denied and underpaid orthopedic medical claims by executing payer-specific denial recovery workflows with a high level of accuracy and efficiency. This role focuses on post-payment denials and unpaid claims, managing appeals from initial denial through final resolution. The specialist works within standardized playbooks and performance metrics to directly impact client cash flow and recovered revenue. This is a production-driven, outcomes-focused role suited for professionals who thrive in structured, KPI-driven environments and take ownership of financial results.

Key Responsibilities:

Denial Recovery & Appeals

• Work assigned denial and underpayment claim queues, including post-pay denials, medical necessity, bundling, timely filing, and workers' compensation claims
• Prepare, submit, and track appeals in accordance with payer
• and CPT-specific guidelines
• Follow up with insurance payers via phone, online portals, and written correspondence until final resolution
• Ensure timely progression of claims and avoid preventable delays in follow-up

Documentation & Accuracy:

• Accurately document all claim actions, appeal submissions, and payer communications
• Upload, organize, and maintain required clinical and billing documentation
• Maintain clean, complete, and audit-ready records suitable for internal leadership and client review
• Meet high accuracy standards while maintaining daily and weekly productivity targets Workflow Execution & Collaboration
• Adhere to standardized recovery playbooks and escalation thresholds
• Escalate complex or unusual denial patterns appropriately
• Collaborate with leadership, QA, and strategy teams to improve recovery outcomes
• Identify and report payer trends, denial patterns, and workflow improvement opportunities We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day.

We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.

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https://insightglobal.com/workforce-privacy-policy/. Skills and Requirements

• 2+ years of experience in medical billing, accounts receivable (A/R), and/or denial recovery
• Experience supporting orthopedic or specialty healthcare practices
• Hands-on experience working insurance denials and appeals through resolution
• Experience with commercial insurance payers (e.g., BCBS, Aetna, UnitedHealthcare, Cigna)
• Strong attention to detail and commitment to documentation accuracy
• Comfortable working in productivity
• and metrics-driven environments
• Work-from-home setup including a personal computer and wifi
• Demonstrated success recovering high-dollar or complex denials
• Prior experience in structured, high-performance revenue cycle teams
• Familiarity with appeal success metrics, accuracy benchmarks, and throughput goals
• Experience identifying payer trends or contributing to workflow optimization