Claims Resolution Specialist

Job Description

Claims Resolution Specialist (Remote)

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.

Qualifications

• 3+ years of experience in healthcare revenue cycle, medical billing, claims processing, accounts receivable, insurance follow-up, denials management, appeals, or reimbursement.
• Experience working with Medicare, Medicaid, commercial insurance, and managed care payers.
• Knowledge of claims resolution, EOBs, ERAs, payer portals, claim corrections, appeals, and reimbursement processes.
• Familiarity with CPT, ICD-10, HCPCS coding, medical terminology, and healthcare regulations.
• Proficiency with Microsoft Office (especially Excel) and healthcare systems such as Epic, Cerner, Meditech, Athena, NextGen, Facets, Availity, or similar platforms.
• Strong analytical, problem-solving, organizational, and communication skills.
• Ability to manage high-volume workloads, prioritize tasks, and work independently in a remote environment.
• Revenue cycle, coding, billing, or healthcare-related certifications are a plus.

Benefits

• Competitive pay based on experience
• Medical, Dental & Vision Insurance
• 401(k) with company match
• Paid Time Off (PTO) and Paid Holidays
• Life Insurance and Disability Coverage
• Employee Assistance Program (EAP)
• Professional development and career growth opportunities
• Remote work environment
• Supportive and collaborative team culture
• Equipment provided

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, Los Angeles County Fair Chance Ordinance, and San Francisco Fair Chance Ordinance.


Job Reference: JN -092026-430137