Clinical Denials Specialist

About This Clinical Denials Specialist Role

Firstsource Solutions USA, LLC is hiring for a Clinical Denials Specialist position connected to Remote, US. This Bellencia Career Hub summary translates the original job posting into a structured, easier-to-scan career lead for job seekers comparing remote, hybrid, back-office, healthcare, billing, and administrative opportunities.

The role appears to focus on accurate account work, structured documentation, research, and timely follow-through. Candidates should review the official posting carefully before applying because employer needs, schedules, location rules, and application requirements can change.

Key Responsibilities

Daily Work You May Handle

• Research payer denials related to referrals, authorizations, notifications, medical necessity, and non-covered services
• Review claims and determine whether resubmission, retro authorization, written appeal, or no action is needed
• Write and submit professional appeal letters
• Use clinical documentation, payer medical policies, and contract language to support appeals
• Track appeal outcomes and denial trends
• Prepare reports for management review
• Review utilization review and coverage guidelines for multiple payers
• Identify process improvement opportunities
• Ensure denial management activities comply with HIPAA, federal, state, and payer regulations
• Resolve accounts in a timely manner

The core workflow centers on accuracy, research, and keeping accounts or records moving through the correct process. A strong applicant should be comfortable reviewing details, comparing information across systems, updating records, and documenting outcomes in a way that supports clean handoffs between departments.

Minimum Requirements

Education, Experience, and Technical Knowledge

• Associate degree in a business or healthcare-related field
• Registered Nurse certification with experience in care management, utilization review, prior authorization, and appeals
• Electronic Health Record experience with platforms such as Epic, Cerner, or Meditech
• Proficient PC knowledge
• Ability to type 30-40 words per minute
• Professional written and verbal communication skills
• Strong organization and time management skills
• Ability to prioritize multiple tasks in a busy work environment

For this type of role, employers often look for a mix of practical experience, system confidence, and the ability to understand payer, billing, account, or documentation rules. Even when the role is not heavily phone-based, communication still matters because the work may involve coordination with internal teams, management, or partner departments.

Preferred Qualifications

Helpful Background for Stronger Applicants

• Knowledge of insurance payers
• Clinical denial management experience
• Utilization review experience
• Prior authorization experience
• Clinical appeals experience
• Experience with payer medical policies and contract language

Phone Level and Work Style

Bellencia phone-level estimate: Low to Moderate Phone. This classification is based on the wording in the pasted posting. Because this is an estimate, applicants who need non-phone or low-phone work should confirm phone expectations during the interview. The posting reads most strongly as Clinical Denials / Appeals work with a focus on written records, account review, payer details, research, and follow-up.

Pay, Schedule, and Location Details

Pay: not listed in the pasted posting. Schedule: Monday-Friday, 8:00 AM-4:30 PM EST 8:00AM-4:30PM. Job type: Full-time. Location or work arrangement: Remote, US. Applicants should verify the official application page for the most current pay range, benefits, shift expectations, equipment rules, and state eligibility requirements.

Best-Fit Applicant Profile

This role may be a good match for someone who enjoys detailed, process-driven work and can stay consistent with repetitive but important tasks. It may fit job seekers with experience in medical billing, revenue cycle, accounts receivable, claims, refunds, charge capture, payer research, payment posting, documentation review, insurance eligibility, or healthcare administrative support.

• You are comfortable researching account details and correcting issues before they become larger problems.
• You can follow written procedures and keep documentation clean, accurate, and audit-ready.
• You prefer structured back-office work over sales-driven or heavy call-center duties.
• You can manage confidential information professionally and escalate unclear issues when needed.

Resume Keywords to Consider

Relevant resume keywords may include Clinical Denials Specialist, Medical / Healthcare, Clinical Denials / Appeals, Revenue Cycle, Insurance Verification, documentation, account research, workflow queues, Excel, payer requirements, reconciliation. Use only the keywords that honestly match your experience. The strongest applications usually connect past duties directly to the employer’s listed responsibilities.

How to Apply

Use the official application link for this job posting when you are ready to apply. Before submitting, review the required experience, confirm the schedule, and tailor your resume summary and bullet points toward the highest-priority duties in this listing.