Medical Claims Recovery & Denial Specialist

Medical Claims Follow- up SpecialistReports To: Credentialing, Contracts & Medical Claims ManagerDepartment: FinancePay Range: $18-$21 an hourEssential Duties & ResponsibilitiesClaims Follow-Up & ResolutionPerform active, high-volume follow-up on unpaid, delayed, and aging claims across all service lines and payers using payer portals, telephone, and written correspondence.Monitor claims aging reports to prioritize follow-up activity and prevent timely filing losses.Troubleshoot claim issues by researching payer responses, remittance advice, and system records to identify the root cause of non-payment or denial.Communicate with payers through appropriate channels to resolve outstanding balances and obtain payment status updates.Identify patterns in denials or payment delays and escalate trends to the Credentialing, Contracts & Medical Claims Manager.Support the appeals process with guidance from leadership; escalate complex or high-value appeals as needed.Maintain awareness of payer-specific follow-up requirements, timely filing windows, and claim dispute processes across multiple state Medicaid programs and managed care organizations.Payment Posting & Denial ManagementPost payments and denials into TherapyNotes and RevConnect accurately and within established turnaround standards.Reconcile posted payments against remittance advice and payer explanations of benefits (EOBs) to ensure accuracy.Identify underpayments, contractual adjustments, and erroneous denials and take appropriate action or escalate as needed.Ensure denial reason codes are accurately captured and documented to support reporting and root cause analysis.Claim Routing & CollaborationRoute unpaid or denied claims requiring correction or resubmission to the Claims Specialist – Submission with clear, documented instructions regarding the required action.Collaborate with the Claims Specialist – Submission to ensure routed claims are resolved and resubmitted within payer timelines.Coordinate with the Credentialing, Contracts & Medical Claims Manager to resolve complex payer issues, authorization discrepancies, or contract-related denials.Communicate effectively with internal departments including admissions, clinical, and accounting to resolve documentation or eligibility issues contributing to non-payment.Documentation & Audit SupportLog all follow-up activity, payment posting, and claim dispositions in TherapyNotes and RevConnect in a clear, complete, and audit-ready format.Maintain organized records of denial rationale, appeal submissions, and resolution outcomes.Support month-end close activities by ensuring outstanding claims and payment postings are current and accurately reflected in the claims system.Adhere to HIPAA requirements and internal policies governing the handling of confidential patient and financial information.Productivity & Continuous ImprovementMeet or exceed weekly and monthly productivity, resolution, and posting turnaround standards established by leadership.Adapt to payer rule changes, new service line rollouts, and internal workflow improvements.Participate in cross-training and provide backup support to the Claims Specialist – Submission as directed.Contribute to process improvement efforts aimed at reducing denial rates, accelerating collections, and improving claims system accuracy.QualificationsHigh School Diploma or GED required.Minimum two years of medical claims follow-up, accounts receivable, or insurance billing experience required, with an emphasis in government payers.Experience in behavioral health billing and follow-up strongly preferred.Comfort with multi-state claims and payer guidelines preferred.Proficiency with Microsoft Office (Excel, Outlook, Teams) and EMR or claims management software required.Experience with TherapyNotes or RevConnect a plus.Knowledge, Skills, and AbilitiesStrong attention to detail and accuracy in payment posting and claim documentation.Persistence and sound judgment in navigating payer representatives, portals, and appeals processes.Ability to manage a high volume of outstanding claims simultaneously while maintaining accuracy and meeting deadlines.Working knowledge of Medicaid, managed care, and commercial payer billing requirements, denial codes, and remittance processes.Understanding of revenue cycle workflows, including the relationship between claims submission, follow-up, and payment posting.Excellent written and verbal communication skills, including comfort with payer-facing correspondence.High level of integrity and discretion when handling confidential patient and financial information.Team-oriented with a commitment to supporting organizational cash flow and billing compliance.Lakemary provides competitive compensation and benefit package including medical, dental, vision, and life insurance plans; paid time off; and a 401(k)-retirement planCertifications:Lakemary provides training in program specific coursework.Special Considerations:Some environments/shifts require same sex staff due to regulatory requirements.All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. EEODiversity, Equity, and Inclusion (DEI) Statement:For the last 50 years we have been working to create workplaces that reflect the communities we serve and a place where everyone feels empowered to bring their full, authentic selves to work. We embrace this from our mission. #J-18808-Ljbffr Lakemary-Center,-Inc