About the Role
This position is responsible for analyzing, resolving, and appealing denied insurance claims while maintaining compliance with payer guidelines and internal policies. The representative will coordinate with providers, billing departments, and payers to ensure proper reimbursement.
Responsibilities
- Review and interpret insurance denials for medical claims
- Determine root causes of claim rejections and identify corrective actions
- Prepare and submit appeals for denied claims following payer protocols
- Communicate with insurance carriers to resolve outstanding issues
- Track denial trends and report findings to management
- Ensure timely follow-up on unpaid or underpaid claims
- Verify claim accuracy before resubmission
- Maintain detailed records of all denial and appeal activities
- Collaborate with clinical and administrative staff to gather required documentation
- Adhere to regulatory standards and payer-specific billing requirements
- Monitor account statuses and update resolution progress
- Respond to internal inquiries regarding claim status
- Utilize billing systems to manage claims workflow
- Escalate complex cases to supervisors when necessary
- Support process improvements to reduce denial rates
- Meet performance metrics related to denial resolution timelines
- Stay current with changes in insurance policies and coding guidelines
Compensation
Competitive hourly rate commensurate with experience
Work Arrangement
Remote with eligibility restricted to residents of Illinois, Indiana, Iowa, or Wisconsin
Team
Part of the revenue cycle management team focused on claims resolution
Required Licenses or Certifications
None required, but CPC or CPB certification is a plus
Physical Requirements
- Prolonged periods of sitting and computer use
- Frequent typing and mouse operation
- Occasional lifting of up to 10 pounds
Work Environment
- Remote position with secure home office setup
- Standard business hours with occasional overtime during peak periods
Background Check
Position requires a criminal background check and verification of work history
Onboarding Process
New hire training program includes system orientation and compliance modules
Performance Evaluation
Quarterly reviews based on accuracy, timeliness, and adherence to procedures
Professional Development
Opportunities for continuing education in medical billing and coding
Technology Requirements
- High-speed internet connection
- Secure, private workspace
- Company-provided laptop and software tools
Travel Requirements
No regular travel expected; occasional in-person meetings may be requested
Equal Opportunity Employer
Committed to diversity and inclusion in the workplace
Not available
