claims resolution specialist

TriStar Health

<div><h5 class="jobSectionHeader">Introduction</h5>
This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).
Do you want to join an organization that invests in you as a Claims Resolution Specialist? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.<h5 class="jobSectionHeader">
Benefits</h5>
Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing 
</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) 
</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock 
</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance. 
</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more 
</li><li>
Consumer discounts through Abenity and Consumer Discounts 
</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships 
</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships) 
</li><li>
Colleague recognition program 
</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) 
</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location. 
You contribute to our success. Every role has an impact on our patients&rsquo; lives and you have the opportunity to make a difference. We are looking for a dedicated Claims Resolution Specialist like you to be a part of our team.<h5 class="jobSectionHeader">
Job Summary and Qualifications</h5> 
The Claims Resolution Specialist is responsible for applying fundamental knowledge of healthcare revenue cycle practices and procedures as it relates to researching, analyzing, and resolving open insurance claims and balances. This job requires regular outreach to payors. 
 
In this role you will: 
<ul><li>
Conduct follow-up with payors, vendors, and clearinghouse on open insurance claims and balances in compliance with departmental policies and procedures</li><li>
Resubmit primary and secondary claims</li><li>
Identify potential claim issues and escalate to management</li><li>
Review, identify, and resolve payor denials</li><li>
Update patient accounts as appropriate</li><li>
Ensure adjustments are posted timely and correctly for claims that need to be adjusted</li><li>
Resolve claims impacted by payor recoupments and refunds Meet and maintain established departmental performance metrics for production and quality</li><li>
Maintain working knowledge of workflow, systems, and tools used in the department</li></ul> 
 Qualifications: 
<ul><li>
Minimum one-year related healthcare experience preferred.</li><li>
Relevant education may substitute experience requirement.</li><li>
Previous Call Center experience is preferred</li><li>
Virtual employees are required to have high speed wired internet speed 25 MBS Download and 6 MBS Upload</li></ul> 
Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
&quot; 
&quot;Good people beget good people.&quot;- Dr. Thomas Frist, Sr. 
HCA Healthcare Co-Founder
We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Claims Resolution Specialist opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

Claims Resolution Specialist

Medical City Healthcare

MPF Federal

<div>The Dental Claims Resolution Specialist I is responsible for entering and processing dental claims in the claims system. This role requires attention to detail, strong problem-solving skills, and the ability to follow established guidelines to ensure claims are processed accurately and on time.
Compensation: Pursuant to Service Contract Act - Starting at $17.00
You will review claim submissions, enter claim information into the system, identify errors or missing information, and help ensure claims move through the process efficiently.
Key Responsibilities<ul><li>
Enter dental claim information into the claims processing system from paper, portal, or fax submissions
</li><li>Review claims for accuracy and correct OCR or data entry errors
</li><li>Monitor and respond to questions from the claims email queue
</li><li>Assist with resolving claims that fail electronic processing (EDI errors)
</li><li>Track claims issues using spreadsheets to ensure claims are processed within required timelines
</li><li>Research and resolve moderately complex claims issues
</li><li>Follow the full claim lifecycle to ensure claims are processed and resolved properly
</li><li>Communicate with internal teams to resolve claim issues when needed</li></ul>
Work Environment<ul><li>
Fully remote position (U.S.-based employees only)
</li><li>Work hours will be communicated during the hiring process
</li><li>Company equipment and systems will be provided for performing job duties</li></ul> 

Requirements 
 
Required Qualifications<ul><li>
At least 3 years of claims processing or related experience (dental experience preferred)
</li><li>Strong attention to detail and problem-solving skills
</li><li>Proficiency with Microsoft Office (Excel, Word, Outlook)
</li><li>Ability to work independently and as part of a team
</li><li>Strong written and verbal communication skills
</li><li>Ability to manage multiple tasks and adapt to changing priorities
</li></ul>Preferred Qualifications<ul><li>
Dental claims processing experience
</li><li>Dental office or dental assisting background
</li><li>Associate degree in Business Administration or a related field
</li><li>Dental or medical coding experience
</li><li>Healthcare or medical call center experience</li></ul> 

Benefits 
MPF Federal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. We offer a competitive compensation package including a competitive salary, medical benefits, PTO, holiday pay and more.</div>

Dental Claims Resolution Specialist - TEMP

Metro Vein Centers

<div><div>Metro Vein Centers is a rapidly growing healthcare practice specializing in state-of-the-art vein treatments. Our board-certified physicians and expert staff are on a mission to improve people's quality of life by relieving the painful, yet highly treatable symptoms of vein disease&mdash;such as varicose veins and heavy, aching legs.

With over 60 clinics across 7 states, and still growing, we're building the future of vein care&mdash;delivering compassionate, results-driven care in a modern, patient-first environment.

We proudly maintain a Net Promoter Score (NPS) of 93, the highest patient satisfaction in the industry.</div>
We're seeking a detail-oriented, results-driven Claims Resolution Specialist to support our billing and revenue cycle operations. In this role, you'll manage assigned claims, follow up on denials, ensure accurate and timely payment, and support the financial health of our clinics through effective payer engagement.

This is a hybrid position based in West Bloomfield, MI.

What You'll Do
<ul>
<li>Investigate and resolve claim denials and underpayments from insurance providers</li>
<li>Research payer-specific policies and submit accurate, timely appeals</li>
<li>Follow up on unpaid or delayed claims using payer portals and internal billing systems</li>
<li>Monitor aging reports and prioritize claims follow-up based on timely filing and payer deadlines</li>
<li>Perform insurance re-verification as needed and reprocess claims to appropriate payers</li>
<li>Accurately post payments and adjustments, including co-payments, deductibles, and coinsurance</li>
<li>Support billing operations, including charge entry, rejection resolution, and documentation reviews</li>
<li>Collaborate with internal teams to escalate payer issues and reduce future denials</li>
<li>Maintain meticulous records of follow-ups, appeal status, and payment resolutions in the EMR</li>
</ul><h3 class="jobSectionHeader">What You'll Bring</h3>
<ul><li>2+ years of experience in medical billing, claims resolution, or insurance follow-up</li>
<li>Solid understanding of insurance guidelines, claim cycles, and payer behavior</li>
<li>Proficiency with CPT, ICD-10, and medical billing workflows</li>
<li>Comfortable using payer portals, EMR systems, and Excel/Google Sheets</li>
<li>Organized, self-motivated, and accountable with strong time management skills</li>
<li>Clear written and verbal communication when working with both payers and internal teams</li>
<li>High school diploma or equivalent required</li>
</ul><h3 class="jobSectionHeader">Preferred Skills</h3>
<ul><li>Familiarity with Centricity EMR</li>
<li>Previous experience in surgical or specialty practice billing</li>
<li>Knowledge of revenue cycle metrics and KPIs</li>
</ul><h3 class="jobSectionHeader">Benefits to Support Your Wellbeing &amp; Lifestyle</h3>

Full-time team members at Metro Vein Centers are eligible for:
<ul>
<li>Medical, Dental, and Vision Insurance</li>
<li>401(k) with Company Match</li>
<li>Paid Time Off (PTO) + Paid Company Holidays</li>
<li>Company-Paid Life Insurance</li>
<li>Short-Term Disability Insurance</li>
<li>Employee Assistance Program (EAP)</li>
<li>Career Growth &amp; Development Opportunities</li>
</ul>
Schedule
<ul>
<li>Monday - Friday</li>
<li>This is a hybrid position based in West Bloomfield, MI.</li>
<li>Monday-Friday: 8:30am-5:00pm</li>
</ul>
#LI-hybrid<div>
The Metro Vein Centers Difference

Healthy legs. Happier lives. 
At Metro Vein Centers, we believe exceptional care begins with an exceptional experience. Our mission is to make vein care approachable, empowering, and connected to overall well-being. From the first conversation to the final follow-up, every patient interaction reflects our commitment to compassion, expertise, and trust.

A team united by purpose. 
Our values guide everything we do:
<ul>
<li>Patients First, Always &ndash; Every interaction should make our patients feel valued, heard, and cared for.</li>
<li>Stronger Together &ndash; Teamwork and collaboration drive our success. We lift each other up to deliver the best for our patients.</li>
<li>A Can-Do Spirit &ndash; We meet every challenge with positivity, flexibility, and problem-solving energy.</li>
<li>Results That Make a Difference &ndash; We're driven to improve lives through meaningful, measurable outcomes.</li>
<li>Commitment to Growth &ndash; We invest in our people, fostering advancement and professional development at every level.</li>
</ul>
Metro Vein Centers is an Equal Opportunity Employer. 
We're committed to creating a workplace where everyone feels seen, heard, and supported. We do not discriminate based on race, color, religion, sex, national origin, age, disability, genetics, gender identity or expression, sexual orientation, veteran status, or any other protected status in accordance with applicable federal, state, and local laws. This policy applies to all aspects of employment, including recruitment, hiring, promotion, compensation, benefits, and termination.

Legal &amp; Compliance Notice: 
Metro Vein Centers complies with all applicable federal, state, and local employment laws, including those related to nondiscrimination, equal opportunity, and pay transparency. Where specific disclosures or postings are required by law, we provide this information as part of our hiring process or upon request.

Your privacy matters. 
To learn more about how we collect, use, and protect your information, please review our privacy policy here.</div></div>

Medical Claims Resolution Specialist

VieMed, LLC

<div>Duties:
<div><ul><li>Review and understand Insurance policies and standard Explanation of Benefits.</li></ul>
<ul><li>Review and understand medical documentation effectively</li></ul>
<ul><li>Review and resolve Back Collections related tasks, such as
<div><ul><li>Denial appeals</li></ul>
<ul><li>Payment review and balance billing</li></ul>
<ul><li>Claims generation</li></ul>
</div></li></ul><ul><li>Establishes and maintains effective communication and good working relationships with insurance carriers, patients/family, and other internal teams for the patient&rsquo;s benefit.</li></ul>
<ul><li>Performs other clerical tasks as needed, such as
<div><ul><li>Answering patient/Insurance calls</li></ul>
<ul><li>Faxing and Emails</li></ul>
</div></li></ul><ul><li>Communicates appropriately and clearly to Manager/Supervisor, and other superiors. Reports all concerns or issues directly to Revenue Cycle Manager and Supervisor</li></ul>
<ul><li>Other responsibilities and projects as assigned.</li></ul></div> 


Requirements:
<ul><li>High School Diploma or equivalent</li>
<li>Knowledge of Explanation of Benefits from insurance companies</li>
<li>General knowledge of government, regulatory billing and compliance regulations/policies for Medicare &amp; Medicaid</li>
<li>Working knowledge of CPT and ICD-10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits.</li>
<li>Enough knowledge of policies and procedures to accurately answer questions from internal and external customers.</li>
<li>Utilizes initiative while maintaining set levels of productivity with consistent accuracy.</li></ul> 


Experience:
<ul>
<li>3-5 Years in DME or medical billing experience preferred.</li>
<li>Minimum of 1 year of insurance verification or authorizations required.</li></ul> 


Skills:
<ul>
<li>Superior organizational skills.</li>
<li>Proficient in Microsoft Office, including Outlook, Word, and Excel.</li>
<li>Attention to detail and accuracy.</li>
<li>Effective/professional communication skills (written and oral)</li></ul></div>

Macrise Tech Solutions

Accounts Receivable &amp; Denial Management<ul><li>Monitor and manage outstanding insurance claims to support the reduction of overall Accounts Receivable (AR).</li><li>Perform consistent follow-ups on denied claims to ensure timely resolution and claim recovery.</li><li>Analyze Electronic Remittance Advice (ERA) reports to identify denial trends and recommend corrective actions to prevent recurrence.</li><li>Prepare, submit, and track appeals for denied or underpaid claims while ensuring all required documentation is complete and accurate.</li><li>Investigate payment discrepancies and escalate complex issues to the Billing Manager when necessary.</li><li>Maintain updated AR aging reports and provide regular weekly and monthly performance summaries.</li><li>Handle billing and claim management for specialized services such as TMS, Spravato, and psychological assessments.</li><li>Work collaboratively with the Billing Manager to achieve AR reduction, recovery, and billing accuracy objectives.</li></ul>Patient &amp; Provider Communication<ul><li>Respond promptly and professionally to billing-related inquiries from patients, providers, and internal teams.</li><li>Review and verify patient account details to ensure accuracy before initiating collections or claim follow-ups.</li><li>Coordinate with healthcare providers to resolve claim issues related to coding errors or missing documentation.</li><li>Communicate with insurance payers to address eligibility verification, prior authorization requirements, and network participation matters.</li><li>Address patient billing concerns with professionalism and empathy, including processing refunds when applicable.</li></ul>Systems Management &amp; Process Improvement<ul><li>Create, monitor, and resolve billing-related support tickets within the eClinicalWorks (eCW) system.</li><li>Provide guidance and support to team members on AR follow-up strategies and denial management procedures.</li><li>Coordinate with U.S.-based billing teams to facilitate accurate and timely claims submission.</li><li>Participate in operational meetings and performance reviews to evaluate trends and recommend workflow improvements.</li><li>Stay updated on payer guidelines, regulatory requirements, and industry best practices related to medical billing and reimbursement.</li></ul>Job Type: Full-timePay: Rs45,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Required)</li></ul>Application Question(s):<ul><li>Willing to work the night shift in Wapda Town, Lahore?</li></ul>Experience:<ul><li>Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

AR & Claims Resolution Specialist

Minnesota Mental Health Clinics

<div>Job Title: Billing Specialist 
Company: MMHC (Minnesota Mental Health Clinics)

Position Overview 
Minnesota Mental Health Clinics (MMHC) is seeking a detail-oriented Billing Specialist to support our revenue cycle operations within a behavioral health setting. This role is primarily focused on denial management and resolving outstanding claims to ensure timely and accurate reimbursement.

The ideal candidate brings experience in healthcare billing (behavioral health preferred) and is comfortable navigating billing platforms such as NextGen or Netsmart. This is a great opportunity for someone who enjoys problem-solving, working independently, and contributing to the financial health of a growing organization.

Key Responsibilities
<ul>
<li>Manage and resolve denied claims in a timely and efficient manner</li>
<li>Investigate claim denials, identify root causes, and implement corrective actions</li>
<li>Follow up on outstanding insurance claims to ensure prompt reimbursement</li>
<li>Submit corrected claims and appeals as needed</li>
<li>Collaborate with internal teams to resolve billing discrepancies</li>
<li>Maintain accurate documentation of billing activity and claim status</li>
<li>Ensure compliance with payer requirements and healthcare regulations</li>
</ul>
Qualifications
<ul>
<li>Previous experience in medical billing required; behavioral health experience preferred</li>
<li>Familiarity with denial management and claims resolution processes</li>
<li>Experience with NextGen and/or Netsmart systems preferred</li>
<li>Strong attention to detail and problem-solving skills</li>
<li>Excellent organizational and time management abilities</li>
<li>Ability to work both independently and collaboratively</li>
</ul>
Preferred Skills
<ul>
<li>Knowledge of insurance guidelines, including Medicare, Medicaid, and commercial payers</li>
<li>Strong communication skills for payer follow-up and internal coordination</li>
<li>Proficiency with EHR and billing systems</li>
</ul>
Compensation &amp; Work Arrangement
<ul>
<li>Hourly pay up to $28/hour, depending on experience</li>
<li>Flexible work options: on-site, hybrid, or fully remote</li>
</ul>
Benefits
<ul>
<li>Healthcare insurance including Medical and Dental.</li>
<li>401K and Roth IRA Retirement Match.</li>
<li>Paid Time Off.</li></ul></div>

Billing Specialist

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