This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Priority Claims Specialist based in the United States.
This role offers the opportunity to make a direct impact by ensuring accurate and timely reimbursement within a complex healthcare revenue cycle environment.
As a Priority Claims Specialist, you will manage high-value claims, resolve payment challenges, and support efficient collections processes.
You will work remotely as part of a collaborative team focused on improving financial outcomes while maintaining compliance with healthcare regulations.
The position requires strong analytical skills, attention to detail, and the ability to navigate complex insurance policies and reimbursement requirements.
You will partner with internal teams, insurance providers, and external stakeholders to resolve outstanding accounts and optimize claim resolution.
This is an ideal opportunity for a detail-oriented professional who enjoys problem-solving and contributing to better healthcare operations.
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Priority Claims Specialist based in the United States.
This role offers the opportunity to make a direct impact by ensuring accurate and timely reimbursement within a complex healthcare revenue cycle environment.
As a Priority Claims Specialist, you will manage high-value claims, resolve payment challenges, and support efficient collections processes.
You will work remotely as part of a collaborative team focused on improving financial outcomes while maintaining compliance with healthcare regulations.
The position requires strong analytical skills, attention to detail, and the ability to navigate complex insurance policies and reimbursement requirements.
You will partner with internal teams, insurance providers, and external stakeholders to resolve outstanding accounts and optimize claim resolution.
This is an ideal opportunity for a detail-oriented professional who enjoys problem-solving and contributing to better healthcare operations.
Accountabilities:
- Utilize billing and collections systems to identify, investigate, and resolve unpaid, underpaid, and denied claims.
- Review explanations of benefits (EOBs), insurance correspondence, and payment details to verify accurate reimbursement based on contracts, policies, and regulations.
- Follow up with insurance companies through online portals, phone, email, and fax to resolve outstanding balances.
- Identify billing errors, submit corrected claims, and manage claim resolution activities through completion.
- Prepare, submit, and follow up on appeals, disputes, and documentation requests.
- Research insurance guidelines, reimbursement policies, and coverage requirements to support successful claim outcomes.
- Perform account adjustments and process updates according to established procedures.
- Maintain detailed and accurate documentation of all account activities, findings, and resolutions.
- Submit medical records and supporting documentation when required by payors.
- Resolve complex accounts receivable issues and respond to inquiries from internal teams, patients, and external partners.
- Monitor assigned accounts, reports, and encounters to identify trends and opportunities for improvement.
- Communicate collection challenges and potential payment delays to management.
- Collaborate effectively with patient care teams to support successful collection efforts.
- Ensure compliance with healthcare regulations, privacy requirements, and established reimbursement practices.
- High school diploma or equivalent required.
- 4+ years of experience working with payer policies, reimbursement processes, medical claims, and insurance appeals.
- Strong understanding of medical billing, reimbursement guidelines, and insurance regulations.
- Experience managing complex denials, appeals, and high-dollar medical collections preferred.
- Knowledge of Local Coverage Determinations (LCDs), policy articles, coding requirements, CPT, ICD-10, HCPCS, modifiers, and documentation guidelines.
- Familiarity with medical terminology and healthcare insurance processes.
- Experience with electronic health records (EHR) and automated billing systems preferred.
- Experience with platforms such as NextGen and/or OnBase is a plus.
- Ability to analyze account issues, identify trends, and proactively resolve payment challenges.
- Strong attention to detail with excellent organizational and time management skills.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
- Strong written and verbal communication skills, including professional phone communication.
- Proficiency with Microsoft Office applications and computer-based systems.
- Ability to handle confidential patient and billing information with a high level of integrity and professionalism.
- Self-motivated, resourceful, and capable of working independently in a remote environment.
- Competitive hourly compensation range of $18.00 - $26.00/hour.
- Annual bonus opportunity of up to 5% of base pay, based on applicable performance criteria.
- Fully remote, full-time position with a Monday-Friday daytime schedule.
- Medical, dental, and vision insurance coverage.
- 401(k) savings and retirement plan.
- Paid time off including vacation and sick leave.
- 8 paid national holidays plus additional floating holidays.
- Paid parental bonding leave for new parents.
- Employee referral bonus program.
- Mentorship and professional development opportunities.
- Opportunity to contribute to meaningful healthcare services that support patient mobility and quality of life.
As a Priority Claims Specialist, you will be responsible for managing complex medical claims, improving reimbursement outcomes, and ensuring accurate documentation throughout the collections process. You will analyze denied and unpaid claims, communicate with payors, and collaborate with internal teams to resolve issues while maintaining compliance with applicable regulations.
Requirements:
The ideal candidate is an experienced healthcare claims and reimbursement professional with strong knowledge of insurance processes, medical billing practices, and complex claim resolution strategies.