Revenue Cycle Claims Specialist

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

📋 Description

• Confirm insurance eligibility and benefits for members prior to service delivery.

• Process clean electronic claims via EHR and clearinghouse systems.

• Ensure precise CPT, ICD-10, and modifier coding for behavioral health and telehealth services.

• Track claim statuses and address rejections before adjudication.

• Oversee claims for multiple payers.

• Review denial queues and submit both clinical and administrative appeals.

• Monitor appeal outcomes and report payer trends to management.

• Post EOBs and ERAs to patient accounts while reconciling payments.

• Address underpayments, overpayments, and contractual adjustments.

• Facilitate member refunds and balance transfers.

• Handle member billing inquiries through phone, email, and chat.

• Clarify EOBs, member responsibility amounts, and payment options.

• Resolve billing disputes and document corrections in CRM and EHR systems.

• Maintain precise records of claims, member interactions, and billing adjustments.

• Adhere to HIPAA regulations and company compliance standards.

• Report on denial rates, days in A/R, clean claim rates, and collection metrics to the manager.

⛳️ Requirements

• Minimum of 2 years of experience in medical billing, revenue cycle management, or insurance claims processing.

• Strong understanding of the complete claims lifecycle, including eligibility verification, claims submission, denial management, appeals, and payment posting.

• Proficient in reading and interpreting Explanations of Benefits (EOBs) and Electronic Remittance Advices (ERAs).

• Knowledgeable about deductibles, copays, coinsurance, prior authorization, coordination of benefits, and timely filing.

• Experienced in CPT and ICD-10 coding for behavioral health or telehealth services.

• Familiar with clearinghouse platforms and EHR systems.

• Capable of managing high-volume work queues with meticulous attention to detail and analytical skills.

• Strong written and verbal communication abilities.

• Skilled in clearly explaining billing to members.

🏝️ Benefits

• Comprehensive benefits package, which includes medical, dental, vision coverage, and a 401(k) match.

• 11 recognized company holidays each year.

• PTO based on an accrual system.

• Dynamic startup environment with a mission-driven team culture.

• Office located in downtown Chicago featuring an on-site gym.

• 12 weeks of fully paid parental leave for primary caregivers, and 6 weeks of fully paid leave for secondary caregivers, available to qualifying full-time employees.

• Annual performance-based incentives linked to individual achievements and company-wide objectives.