Claims Escalation & Denials Appeals Specialist

Northpoint Recovery Holdings, LLC; Meridian (ID); Remote; USD 30,000 - 33,000; Full time

Benefits offered by this job

Subsidized health insurance

Paid time off

Employer-sponsored life insurance

Dental, Vision, Disability options

401(k) savings account

Employee assistance program

Job summary

Northpoint Recovery Holdings, LLC in Remote, ID is seeking a Claims Escalation & Denials Appeals Specialist to manage ongoing collections, denial management and accounts receivable for assigned accounts across insurers. You will work with patients, payers, and Northpoint providers to ensure timely payments and pursue appeals when needed.

The ideal candidate will have solid knowledge of CMS, HMO/PPO, Medicare/Medicaid, and payer requirements, and strong communication skills.

Qualifications

• 2+ years of collections, billing reimbursement, payer relations, or medical Accounts Receivable required.
• Experience with commercial insurance billing, Medicaid, and billing software.
• Proficiency with CPT, HCPCS, ICD-10 codes, and payer denial patterns.
• Knowledge of CMS and third-party payer regulations and guidelines.

Responsibilities

• Perform collections to secure medical claims within 28 days.
• Make outbound calls to insurance companies and use payer portals for resolution.
• Coordinate with payers to ensure timely payments for services.
• Document all payer communications in the billing system.
• Prepare appeals when denials are payer errors.
• Collaborate with Utilization Review for prior authorization and medical necessity.

Skills

Collections

Payer relations

Billing software

CPT/HCPCS/ICD-10

Insurance guidelines

EHR/EMR familiarity

Team collaboration

Tools

KIPU EHR

Clearinghouse

Job description

Claims Escalation & Denials Appeals Specialist

Meridian, ID

Job Title: Claims Escalation & Denials Appeals Specialist

Reports To: Corporate Director of Revenue Cycle Management

Location: Remote

Schedule: Monday-Friday 8-5pm MST

Compensation: $22-24/hour

Northpoint Recovery Holdings, LLC began 2009 as Ashwood Outpatient and officially launched the Northpoint platform in 2015. Now celebrating 10 years of growth in 2025, Northpoint is a leading behavioral healthcare provider offering evidence-based treatment for adults with substance use and co-occurring disorders through the Northpoint Recovery brand, and mental health treatment for adolescents through Imagine by Northpoint. Operating under an in-network, commercial insurance model, Northpoint has grown exclusively through de novo expansion—from two facilities to twenty across the Western U.S.—with more planned in both existing and new markets. We’re guided by core values of humility, heart, inspiration, and conviction. Our mission is simple: saving lives and restoring relationships by helping people get their lives back, and treating every individual with empathy and respect.

POSITION SUMMARY: As a key member of the Revenue Cycle Management team, the Claims Escalation & Denials Appeals Specialist is responsible for the ongoing collection, denial management, and accounts receivable of assigned accounts. The Claims Escalation & Denials Appeals Specialist will manage and collect outstanding balances from insurance companies for services rendered to Northpoint patients and clients. This role involves working closely with patients, insurance companies, and Northpoint providers to ensure that all payments are collected in a timely manner, and payer denials/rejections are worked and followed up on to exhaustion, or payment of services. The ideal candidate will have a solid understanding of the entire billing life cycle of a patient, to include verifications, pre-authorization, utilization review, appeals, claims submission, claims adjudication, and denials. The ideal candidate will have strong knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems required.

ESSENTIAL RESPONSIBILITIES AND DUTIES:

• Perform collections to ensure receipt of medical claims within twenty-eight (28) days
• Make outbound telephone calls to insurance companies, and utilize payer portals for claims resolution
• Coordinate with insurance companies to ensure timely payment for services rendered
• Follow existing billing and collection protocols to ensure accurate and timely reimbursement
• Review accounts receivable accounts to ensure accurate reimbursement and identify payer issues affecting payment delays
• Contact payers to get a clear understanding of denials and changes needed to receive payment
• Prepare appeals, when necessary, when claim denials are payer errors
• Document all correspondence with payers in the billing system
• Collaborate and coordinate with Utilization Review for prior authorization/medical necessity documentation
• Knowledge of CMS and Third-party payer regulations and guidelines
• Thorough understanding of Explanation of Benefits
• Maintain accurate records of patient billing and payment information
• Provide reports to management on outstanding balances and collections activity
• Provide excellent communication and customer service skills
• Utilize a strong understanding of insurance billing and coding requirements
• Maintain active working knowledge of Northpoint billing and reimbursement requirements by payer
• Collaborate with RCM team and other departments to ensure successful execution of assigned duties and priorities
• Maintain confidentiality in accordance with established policies and procedures and standards of care
• Adhere to all Company policies and procedures
• Perform other job-related duties as assigned

QUALIFICATIONS/REQUIREMENTS:

• 2+ years of collections, billing reimbursement, payer relations, or medical Accounts Receivable required
• Experience in a healthcare or behavioral health system with multiple levels of care preferred
• Experience working with commercial medical insurance billing, as well as Medicaid, claims submission, and the technical aspects of billing software
• All-in-one practice management, clearing house and billing software required
• Proficient in navigating through payer portals
• Must be proficient in CPT, HCPCS, and ICD-10 Codes, DSMS and ASAM criteria, data entry for various third party billing and payers, and their reimbursement and denial patterns
• Ability to work well in a team environment, with ability to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems required
• KIPU or similar EHR/EMR experience preferred
• Strong organizational skills with the ability to multitask
• Familiarity with major payer guidelines
• Agility in managing multiple priorities concurrently
• Meticulous attention to detail and high level of accuracy is key
• Demonstrated ability to develop both internal and external working relationships
• Proven skills in working independently on several projects concurrently

PREFERRED KNOWLEDGE AND SKILLS:

• Sense of ethics, integrity, and confidentiality about employee and business issues
• Ability to work independently and within a dynamic team environment
• Maintain professional and technical knowledge
• Excellent critical thinking skills and organizational abilities
• Excellent communication skills; ability to communicate clearly and concisely, verbally and in writing
• Quickly and effectively identify and resolve problematic situations
• Comfortable analyzing information and dealing with complexity
• Attention to detail and accuracy
• Able to handle confidential material in a reliable manner
• Ability to interact and communicate with individuals at all levels of organization
• Ability to perform several tasks concurrently with ease and professionalism
• Ability to effectively prioritize workload in a fast-paced environment
• Proficiency with Microsoft Office Suite

FULL-TIME BENEFITS INCLUDE:

• Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s)
• 100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000
• 100% Employer Paid Employee Assistance Program
• Voluntary Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance.
• Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses
• Generous Paid Time Off plan

This job description is not intended, and should not be construed, to be exhaustive lists of all responsibilities, skills, efforts or working conditions associated with this job. It is meant to be an accurate reflection of the principal job elements essential for making fair pay decisions about jobs.

Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA.

Northpoint is an Equal Opportunity Employer. Northpoint is an at-will employer. Employment may be terminated at any time by employee, or employer with or without notice.

Compensation:

$22 - $24 USD

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Northpoint Recovery Holdings, LLC’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.