Claims Resolution Pro: Insurance Revenue Cycle Specialist

SHERLOQ Solutions; Tampa (FL); On-site; USD 25,000 - 30,000; Full time

Benefits offered by this job

Medical insurance

401(k)

Paid time off

Paid holidays

Tuition reimbursement

Supplemental benefits

Job summary

SHERLOQ Solutions in Tampa, FL is seeking a Claims Billing Specialist to act as the communication bridge between healthcare providers and health insurer payers, to expedite claim resolution and maximize reimbursement. You will verify patient and insurance information, navigate provider systems and payer portals, review explanations of benefits, and analyze denials.

The role requires attention to detail, strong written and verbal communication, and the ability to work under pressure in a busy

Qualifications

• High school diploma or equivalent.
• 3 years of healthcare industry experience.
• 1 year in healthcare claims billing, insurance collections, coding, or denials management.
• Acquire HFMA CRCR or AAHAM CRCS within 2 years.

Responsibilities

• Resolve healthcare claims through verbal or online inquiries to payers.
• Navigate provider systems, billing platforms, and payer websites.
• Verify patient, insurance, billing and submission information for accuracy.
• Conduct eligibility inquiries and COB research.
• Analyze payer denials and respond to secure reimbursement.
• Inform Billing & Appeals Specialists on appeals when needed.
• Track payer underpayments, coding issues and denials; report trends.
• Identify basic coding denials and initiate corrections or disputes.
• Check insurance payments for accuracy and contract compliance.
• Research missing payments and obtain documents for posting.
• Maintain professionalism in high-volume environments and meet targets.

Skills

Communication

Interpersonal skills

Attention to detail

Reading EOB

Problem solving

MS 365

Education

High School Diploma

HFMA CRCR / AAHAM CRCS accreditation

Tools

Microsoft 365 (Teams, Outlook, OneDrive, SharePoint)

Job description

SHERLOQ Solutions in Tampa, FL is seeking a Claims Billing Specialist to act as the communication bridge between healthcare providers and health insurer payers, to expedite claim resolution and maximize reimbursement. You will verify patient and insurance information, navigate provider systems and payer portals, review explanations of benefits, and analyze denials.

The role requires attention to detail, strong written and verbal communication, and the ability to work under pressure in a busy