Backend Claims Management Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct investigations and resolve intricate claims, denials, and reimbursement challenges.

• Examine denial patterns and pinpoint root causes to enhance claim results.

• Assist in minimizing aged accounts receivable and optimizing reimbursement effectiveness.

• Elevate complex payer or operational issues as necessary.

• Cultivate expertise in payer policies, reimbursement methods, and client processes.

• Recognize payer trends, emerging risks, and opportunities for process enhancements.

• Collaborate with internal teams to implement solutions that boost operational efficiency and financial outcomes.

• Work alongside Service Managers to enhance client health and revenue cycle efficiency.

• Share insights, recommendations, and performance trends with internal stakeholders.

• Aid in client retention through proactive issue resolution and operational enhancements.

• Offer guidance and training to BPO teams on best practices for claims processing and denial prevention.

• Create and promote standardized procedures that enhance quality and consistency.

• Partner with Revenue Cycle, Operations, and Client Services teams to drive ongoing improvements.

• Enhance revenue cycle effectiveness by reducing denials and aged receivables, increasing clean claim rates, strengthening client health, and implementing scalable operational improvements.

⛳️ Requirements

• Experience in Revenue Cycle Management (RCM), medical billing, or healthcare claims administration.

• Comprehensive knowledge of claims processing, denial management, and payer reimbursement strategies.

• Analytical mindset with the capability to identify trends, conduct root cause analyses, and propose solutions.

• Excellent written and verbal communication skills with the ability to influence cross-functional teams.

• Proficient in data analysis and performance reporting.

• Preferred: experience in healthcare revenue cycle operations, denial prevention, appeals, or payer relations.

• Preferred: background in driving operational enhancements and process optimization.

• Must be eligible to work in the United States without sponsorship.

🏝️ Benefits

• Flexibility to work in your preferred setting—whether in-office, remote, or hybrid—within your country of employment.

• Ongoing investment in your professional development.

• Immediate access to a comprehensive health and wellness benefits package, including an annual wellness stipend.

• 401k plan with a match of up to 4% and immediate vesting.

• Flexible and generous Flexible Time Off (FTO) policy.

• Employee Stock Purchase Program.