Priority Claims Specialist

Accountabilities

• Manage complex medical claims, improve reimbursement outcomes, and ensure accurate documentation throughout the collections process.
• Analyze denied and unpaid claims, communicate with payors, and collaborate with internal teams to resolve issues while maintaining compliance with applicable regulations.
• 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.

Requirements

• Experienced healthcare claims and reimbursement professional with strong knowledge of insurance processes, medical billing practices, and complex claim resolution strategies.
• 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.
• Able 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.

Benefits

• Competitive hourly compensation range of $18.00 - $26.00/hour.
• Anual 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.