Claims and Denials Specialist
Career GuideKey Responsibilities
- Review patient and insurance information for claim accuracy
- Submit claims to insurance payers on time
- Monitor claim status and payment progress
- Investigate denied or underpaid claims to find root causes
- Prepare and submit appeals with supporting documentation
- Request corrections to coding or documentation when needed
- Post payments and adjustments when assigned
- Communicate with insurance representatives to resolve issues
- Update accounts and notes in billing systems and claim portals
- Track denials trends and share findings with leaders
- Follow privacy and security rules for patient information
- Support patient inquiries about insurance status and balances
Top Skills for Success
Attention to Detail
Written Communication
Phone Communication
Time Management
Problem Solving
Customer Service
Medical Billing Knowledge
Insurance Benefits Knowledge
Denials Management
Appeals Writing
Claim Follow-up
Payment Posting
Coding Basics
Revenue Cycle Knowledge
Electronic Health Record Familiarity
Billing Software Proficiency
Data Entry Accuracy
Reporting and Tracking
Compliance Awareness
Career Progression
Can Lead To
Billing Specialist
Denials Analyst
Payment Poster
Patient Accounts Specialist
Collections Specialist
Authorization Specialist
Transition Opportunities
Revenue Cycle Analyst
Claims Supervisor
Billing Team Lead
Revenue Cycle Manager
Compliance Specialist
Medical Coding Specialist
Healthcare Operations Specialist
Common Skill Gaps
Often Missing Skills
Appeals documentation qualityRoot cause analysis for denialsPayer policy knowledgeReporting and trend trackingBilling system efficiencyCoding fundamentalsNegotiation and escalation skills
Development SuggestionsBuild a personal denial playbook by payer, track denial reasons weekly, and practice writing clear appeal narratives. Ask to shadow coding and authorizations teams to understand upstream causes. Create simple reports that show denial volume, denial rate, and recovery amount to demonstrate impact.
Salary & Demand
Median Salary Range
Entry Level$40,000 to $50,000
Mid Level$50,000 to $62,000
Senior Level$62,000 to $78,000
Growth Trend
Steady demand. Hiring remains consistent due to complex insurance rules, ongoing claim volume, and the need to reduce denied claims and speed up cash collection.Companies Hiring
Major Employers
Hospital systemsMedical groupsHealth systemsDental service organizationsRevenue cycle management companiesMedical billing servicesInsurance companiesThird-party administrators
Industry Sectors
HospitalsClinicsPhysician practicesDental practicesBehavioral health providersHome health providersLaboratoriesImaging centersHealth insurance
Recommended Next Steps
1
Learn the top denial reason codes used by your payers and how to prevent them2
Create a repeatable appeal template library and keep it updated3
Set daily follow-up targets for aging claims and document outcomes consistently4
Partner with coding and clinical documentation teams to reduce preventable denials5
Take a medical billing or revenue cycle course to strengthen foundations6
Practice using basic spreadsheets to track worklists and results7
Request ownership of a payer portfolio to build expertise and measurable outcomes8
Update your resume with metrics such as appeal win rate, dollars recovered, and reduction in denial rate