Claims Resolution Specialist

Job Summary

Working remotely, the full-time Claims Resolution Specialist will investigate and resolve claim rejections, denials, and reimbursement issues while collaborating with various teams to ensure accurate and timely claim processing within a multi-specialty healthcare organization.

Key responsibilities

• Investigate and resolve claim rejections and denials, correcting errors and facilitating resubmissions
• Collaborate with accounts receivable and denial management teams to address underpaid claims and prepare appeal documentation
• Participate in claim quality reviews and maintain compliance with payer regulations and organizational policies

Required qualifications

• High School Diploma or equivalent required; Associate degree in a related field preferred
• Minimum 2-4 years of experience in medical billing, claims resolution, or healthcare revenue cycle operations
• Working knowledge of Medicare, Medicaid, and Commercial insurance billing requirements
• Familiarity with CPT, ICD-10-CM, HCPCS, and medical terminology
• Experience in researching and resolving denied or rejected claims