Medical Claims Resolution Specialist

Overview

A rapidly growing healthcare practice specializing in advanced vein treatments is seeking a detail-oriented, results-driven Claims Resolution Specialist to support billing and revenue cycle operations. This role involves managing assigned claims, following up on denials, ensuring accurate and timely payment, and supporting the financial health of multiple clinics through effective payer engagement.

Responsibilities

• Investigate and resolve claim denials and underpayments from insurance providers
• Research payer-specific policies and submit accurate, timely appeals
• Follow up on unpaid or delayed claims using payer portals and internal billing systems
• Monitor aging reports and prioritize claims follow-up based on timely filing and payer deadlines
• Perform insurance re-verification as needed and reprocess claims to appropriate payers
• Accurately post payments and adjustments, including co-payments, deductibles, and coinsurance
• Support billing operations, including charge entry, rejection resolution, and documentation reviews
• Collaborate with internal teams to escalate payer issues and reduce future denials
• Maintain meticulous records of follow-ups, appeal status, and payment resolutions in the electronic medical record (EMR)

Requirements

• 4+ years of experience in medical billing, claims resolution, or insurance follow-up
• 1+ years experience working remotely
• Solid understanding of insurance guidelines, claim cycles, and payer behavior
• Proficiency with CPT, ICD-10, and medical billing workflows
• Comfortable using payer portals, EMR systems, and Excel or Google Sheets
• Organized, self-motivated, and accountable with strong time management skills
• Clear written and verbal communication skills for interacting with payers and internal teams
• High school diploma or equivalent required

Preferred Qualifications

• Familiarity with Centricity EMR
• Previous experience in surgical or specialty practice billing
• Knowledge of revenue cycle metrics and key performance indicators (KPIs)

Compensation & Benefits

• Hourly pay range: $20 - $25 USD, varying based on experience and skill set
• Full-time schedule, Monday through Friday
• Medical, dental, and vision insurance
• 401(k) plan with company match
• Paid time off (PTO) and paid company holidays
• Company-paid life insurance
• Short-term disability insurance
• Employee assistance program (EAP)
• Career growth and development opportunities

Location

This is a remote position with at least 1 year of remote work experience required.