Backend Claims Management Specialist

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

📋 Description

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

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

• Decrease aged accounts receivable and maximize reimbursement effectiveness.

• Elevate complex payer or operational concerns as needed.

• Cultivate expertise in payer protocols, reimbursement strategies, and client workflows.

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

• Collaborate with internal teams to boost operational efficiency and financial results.

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

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

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

• Mentor and guide BPO teams on best practices for claims processing and denial prevention.

• Establish and advocate for standardized processes to enhance quality and consistency.

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

⛳️ Requirements

• Proven experience in Revenue Cycle Management (RCM), medical billing, or healthcare claims handling.

• In-depth knowledge of claims processing, denial management, and payer reimbursement methods.

• Strong analytical skills to identify trends, conduct root cause analyses, and propose solutions.

• Excellent written and verbal communication skills to effectively 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 able to work without sponsorship.

• May require occasional travel to the Corporate Headquarters in Denver, Colorado, or other US office locations.

🏝️ Benefits

• Flexibility to work in a manner and location that suits you best within your country of employment – whether in-office, remote, or hybrid.

• Ongoing investment in your professional development.

• Immediate access to a comprehensive health and wellness benefits package from Day 1, which includes an annual wellness stipend.

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

• Flexible and generous (FTO) time-off policy.

• Employee Stock Purchase Program.