Medical Billing and Claims Resolutions Specialist

Medical Billing & Claims Resolution Specialist

We are seeking an experienced Medical Billing & Claims Resolution Specialist to join our team. This position is ideal for someone with extensive knowledge of medical billing processes and a proven ability to successfully resolve complex insurance claims, denials, and secondary insurance issues.

Position Summary

The Medical Billing & Claims Resolution Specialist will be responsible for managing difficult and aged accounts receivable, researching and appealing denied claims, coordinating secondary insurance billing, and ensuring maximum reimbursement accuracy and efficiency. The ideal candidate is detail-oriented, persistent, organized, and highly knowledgeable in insurance guidelines and payer requirements.

Key Responsibilities

• Investigate and resolve denied, rejected, and underpaid insurance claims
• Work complex accounts receivable including aged claims and secondary insurance claims
• Submit corrected claims and appeals with appropriate documentation
• Communicate with insurance carriers to resolve claim discrepancies and payment delays
• Verify patient insurance coverage and coordination of benefits
• Review EOBs/ERAs and identify reimbursement issues
• Maintain accurate billing records and detailed account notes
• Follow up on outstanding claims in a timely manner
• Collaborate with internal staff to correct billing and coding issues
• Ensure compliance with HIPAA and all billing regulations

Qualifications

• Minimum of 3–5 years of medical billing and claims resolution experience
• Strong experience handling claim denials, appeals, and secondary insurance billing
• Knowledge of commercial insurance, Medicare, and Medicaid processes
• Familiarity with CPT, ICD-10, and HCPCS coding
• Excellent problem-solving and communication skills
• Strong attention to detail and organizational abilities
• Ability to work independently and manage high-volume follow-up
• Experience with EMR/EHR and medical billing software preferred

Preferred Qualifications

• Certification in medical billing or coding (CPB, CPC, CMRS, or similar) preferred
• Experience in specialty billing is a plus
• Prior experience reducing aging accounts receivable and increasing collections

Pay: $22.00 - $30.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Flexible schedule
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Work Location: In person