Claims Resolution Specialist
$58,240–$72,800 year
RemoteCalifornia, United States or Arizona, United States
Job Summary
Investigate and resolve claim rejections, denials, and payer edits by reviewing claim history, medical records, and supporting documentation. Correct billing, coding, and insurance errors, then process corrections, adjustments, and resubmissions in accordance with payer guidelines. Partner with Pre-Billing, Accounts Receivable, and Denials Management teams to prepare appeal documentation and reduce preventable denials. Monitor work queues, communicate directly with insurance carriers, and escalate complex issues. Maintain accurate documentation of resolutions and assist with denial trend reporting. Monday-Friday, 8am-5pm. $28.00 to $35.00 Hourly.
Required Qualifications
- High School Diploma or equivalent
- Minimum 2-4 years of experience in medical billing, claims resolution, denial management, accounts receivable, or healthcare revenue cycle operations
- Working knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial insurance billing requirements
- Knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical terminology
- Experience researching and resolving denied or rejected claims
- Strong analytical and critical thinking skills
- Ability to manage multiple priorities and meet productivity expectations
- Must be available in AZ, CA, NM, NV, OR, TX, or WA
Desired Qualifications
- Associate degree in Healthcare Administration, Medical Billing and Coding, or related field
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