Claims Denial & Appeals Specialist — Flexible Start Times

Orthopaedic Associates of Michigan; Grand Rapids (MI); On-site; USD 42,000 - 64,000; Full time

Job summary

Orthopaedic Associates of Michigan is seeking a Claims Denial & Appeals Specialist in Grand Rapids, MI. The role focuses on reviewing denied claims, preparing appeals, and coordinating with payers to improve reimbursement outcomes.

You will support revenue cycle integrity, perform account reconciliations, and provide financial counseling to patients while ensuring HIPAA compliance and accurate documentation across the office.

Qualifications

• High school diploma or GED required.
• Minimum 1 year of medical billing or related healthcare office experience.
• Knowledge of CPT, ICD-10-CM, HCPCS and modifiers.
• HIPAA knowledge and confidentiality requirements.
• Strong communication, problem-solving, and teamwork abilities.

Responsibilities

• Review denied/underpaid claims and plan appeals.
• Research denial reasons; gather documentation for appeals.
• Communicate with insurers about denials and underpayments.
• Resubmit denied or corrected claims for reimbursement.
• Audit patient accounts for payments and balances.
• Monitor reimbursement activity; flag variances to leadership.
• Identify denial trends; suggest process improvements.
• Provide financial counseling and assist with payment plans.
• Access payer portals for authorization and eligibility checks.
• Maintain confidentiality of patient and payer information.

Skills

Written and verbal communication

Customer service

Microsoft Office

Analytical skills

Multitasking

Time management

Interpersonal skills

HIPAA confidentiality

Payer guidelines interpretation

Billing & AR basics

Education

High school diploma or GED

1 year healthcare billing or revenue cycle experience

1-2 years college coursework in healthcare

Tools

Microsoft Office

Payer portals

Job description

Orthopaedic Associates of Michigan is seeking a Claims Denial & Appeals Specialist in Grand Rapids, MI. The role focuses on reviewing denied claims, preparing appeals, and coordinating with payers to improve reimbursement outcomes.

You will support revenue cycle integrity, perform account reconciliations, and provide financial counseling to patients while ensuring HIPAA compliance and accurate documentation across the office.