Title: Medical Insurance Claims Rejection & Authorization Specialist

Job Summary

We are seeking a detail-oriented and experienced Medical Insurance Claims Rejection Specialist to join our team in-office at our Madison Heights, MI location. This role is critical to our revenue cycle, focusing on resolving complex claim denials, performing comprehensive insurance verifications, and managing the prior authorization process. The ideal candidate is a proactive problem-solver who can navigate multiple payer portals and has a deep understanding of medical billing workflows.

Key Responsibilities

• Claims Resolution: Identify, research, and resolve insurance claim rejections and denials to ensure timely reimbursement.
• Insurance Verification: Perform daily eligibility and benefit verifications using Availity, NaviNet, and various individual carrier websites.
• Prior Authorizations: Initiate and track prior authorization requests for medical services, ensuring all clinical documentation meets payer requirements before the date of service.
• Data Management: Utilize Brightree to manage patient records, track claim status, and document all communication with payers and providers.
• Payer Communication: Contact insurance companies via phone and web portals to appeal denied claims and clarify coverage limitations.
• Workflow Coordination: Collaborate with the billing and clinical teams to prevent recurring rejection trends and ensure clean claim submission.

Qualifications & Skills

• Experience: Minimum 2–3 years of experience in medical billing, claims denial management, or insurance verification.
• Software Proficiency: * Required: Hands-on experience with Availity and NaviNet.
• Major Plus: Prior experience with Brightree is highly valued.
• Technical Knowledge: Strong understanding of ICD-10, CPT, and HCPCS coding, as well as the prior authorization lifecycle.
• Attention to Detail: Ability to spot discrepancies in insurance data and patient records that lead to rejections.
• Communication: Professional verbal and written skills for interacting with insurance adjusters and internal staff.

Schedule & Location

• Position Type: Full-Time, In-Office.
• Location: Madison Heights, MI 48071
• Schedule: Monday – Friday (Standard business hours).

Pay: $17.00 - $20.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person