Denials * Appeals * Revenue Cycle * Reimbursement * Medical Billing * Insurance Claims

Location: Fully Remote
Schedule: Full-Time
Employment Type: Contract-to-Hire

Overview

Are you an expert at resolving denied claims, overturning payer denials, recovering revenue, and navigating complex insurance requirements?

We are seeking a Claims Resolution Specialist to join a growing healthcare revenue cycle team. This role is responsible for investigating claim issues, managing appeals, conducting payer follow-up, resolving reimbursement discrepancies, and driving claims to successful payment.

This opportunity is ideal for professionals with backgrounds in:

• Revenue Cycle
• Medical Billing
• Claims Resolution
• Denials Management
• Appeals
• Healthcare Reimbursement
• Accounts Receivable
• Insurance Follow-Up
• Medical Claims Analysis
• Collections
• Payment Integrity
• Claims Recovery
• Patient Financial Services

Responsibilities

• Investigate denied, rejected, unpaid, and underpaid claims.
• Analyze EOBs, remittance advice, payer correspondence, and claim histories.
• Submit corrected claims, reconsiderations, and formal appeals.
• Contact Medicare, Medicaid, Managed Care, Commercial, and Government payers regarding claim status and reimbursement issues.
• Review claim edits, denials, payment variances, and reimbursement discrepancies.
• Identify root causes of denials and develop resolution strategies.
• Conduct claim research using payer portals and healthcare systems.
• Follow up on aged accounts and outstanding balances.
• Track appeals, denials, recoveries, and reimbursement outcomes.
• Review medical record documentation supporting claim reimbursement.
• Collaborate with billing, coding, patient accounts, finance, and operational teams.
• Ensure HIPAA, CMS, Medicare, Medicaid, and payer compliance.
• Monitor claim aging reports and manage assigned work queues.
• Escalate complex payer disputes when appropriate.
• Identify denial trends and recommend workflow improvements.
• Document all account activity accurately and completely.