Claims Resolution Specialist-I

Innovaccer Analytics; United States; Remote; USD 50,000 - 75,000; Full time

Benefits offered by this job

Generous Paid Time Off

Best-in-Class Parental Leave

Recognition & Rewards

Comprehensive Insurance Coverage

Job summary

Innovaccer Inc. is seeking a Claims Resolution Specialist I to efficiently process medical claims and manage denials in a remote environment. You will leverage Athena and other EMR systems, follow best practices, and communicate effectively with leadership to improve revenue cycle outcomes.

The role requires 3+ years in claims resolution or medical billing, strong CPT/ICD-10 knowledge, and the ability to navigate complex payer processes with accuracy and focus.

Qualifications

• 3+ years of experience in claims resolution or medical billing.
• A minimum of 2 years of documented experience on the Athena billing platform is highly preferred. Additional EMR experience including Cerner, NextGen, and EPIC is a plus.
• Formal certification in medical billing preferred but not required.
• Working knowledge of CPT, ICD-10, and medical terminology.
• Complete understanding of follow-up processes.
• Solid background in AR and overall Revenue Cycle policies and procedures.
• Experience working in a medical billing environment with HIPAA compliance.
• Excellent communications skills.
• Excellent systems experience including EMR and Billing/Collection Systems; multi-system experience preferred.
• Ability to communicate effectively with senior leadership and company personnel.

Responsibilities

• Conduct AR follow-up on front-end scrubs and back-end denials; scrub charges for submission and launch appeals in Athena.
• Review and clear claim edits (registration, insurance, charge, and related issues) for high-volume practices.
• Interpret EOBs and denials across carriers (co-pays, deductibles, co-insurance).
• Demonstrate mastery of appeals processing end-to-end across payer categories.
• Differentiate between appeal, coding review, credentialing review, and adjustment best practices.
• Contact insurers and use portals for appeal, eligibility, remittance, and payment information.
• Report and communicate issues and trends; meet minimum productivity of ~6 denials/hour.
• Maintain focus in a remote environment; pass skills tests; perform other duties as assigned.

Skills

Claims resolution

Medical billing

CPT/ICD-10 knowledge

Communication skills

Project management

HIPAA compliance

Microsoft Office

Education

Bachelor's degree

Medical billing certificate

Tools

Athena billing platform

Cerner

NextGen

EPIC

Job description

About the Role

We at Innovaccer are looking for a Claims Resolution Specialist I (CRS-I). A successful Claims Resolution Specialist (Level-I) team member is responsible for processing medical claims within established best practices as defined by Caduceus standards, client specifics, and industry guidelines. Our client base consists of large-scale multi-specialty/multi-site healthcare organizations throughout the United States. The candidate will demonstrate a working knowledge of revenue cycle processes.

A Day in the Life

• Conduct AR Follow-up both on front end scrubs and back-end denials through best practices. Scrub charges for submission and launch appeals via the Athena billing platform.
• Review and clear claim edits in the system. Types of edits to be worked include registration, insurance, charge, and related issues for high volume practices.
• Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).
• Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
• Differentiate between best practices of appeal, coding review, credentialing review and/or adjustment.
• Contact insurance companies and utilize web portals and websites for appeal, eligibility, remittance, and payment information.
• Candidates must be able to report and communicate issues and trends.
• Meet or exceed productivity expectations of a minimum average of 6 denials per hour (approximately 45 per day), while maintaining accuracy and quality standards.
• Highly productive and able to stay focused in a remote environment.
• Ability to demonstrate mastery of the above essential functions with passing grades in a testing environment.
• Other duties as assigned.

What You Need

Professional Experience

• 3+ years of experience in claims resolution or medical billing.
• A minimum of 2 years of documented experience on the Athena billing platform is highly preferred. Additional EMR experience including Cerner, NextGen, and EPIC is a plus. and able to pass skills test on the platform.
• Formal certification in medical billing preferred but not required. .
• Working knowledge of CPT, ICD-10, and medical terminology.
• Complete understanding of follow-up processes.
• Solid background in AR and overall Revenue Cycle policies and procedures.
• Experience working in a medical billing environment where compliance with protected health information and HIPAA compliance is strongly enforced.
• Excellent communications skills.
• Excellent systems experience and acuity. (EMR and Billing and Collection Systems). Multi-system and multi-specialty experience is preferred.
• Proficiency in Microsoft Office Suite, including Word and Excel.
• Bachelor's degree, medical billing certificate preferred.
• Ability to communicate orally and in writing in a clear and straightforward manner.
• Ability to communicate effectively with senior leadership and company personnel.
• Ability to effectively plan/manage/lead projects.
• Ability to make decisions and solve problems while working under pressure.
• Ability to prioritize and organize effectively.
• Ability to show judgment and initiative and to accomplish job duties.
• Ability to work independently.
• Strong business acumen
• Effective communication skills including public speaking.

Work Environment

• A standard business environment exists with moderate noise levels.
• Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
• Ability to sit for extended periods of time.
• Long periods of computer usage
• Handling - seizing, holding, grasping and fingering of objects, tools and controls
• Vision - close vision
• Hearing- ability to receive detailed information through oral and telephonic communication

We offer competitive benefits to set you up for success in and outside of work.

Here's What We Offer

• Generous Paid Time Off: Recharge and relax with 20 days of fixed time off per year, in addition to company holidays - because we believe work-life balance fuels performance.
• Best-in-Class Parental Leave: Spend quality time with your growing family. We offer one of the industry's most generous parental leave policies to support you during life's most important moments.
• Recognition & Rewards: We celebrate wins - big and small. Get rewarded with monetary incentives and company-wide recognition for your impact and dedication. Your hard work won't go unnoticed.
• Comprehensive Insurance Coverage: Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance.

Innovaccer Inc. is an equal opportunity employer. We celebrate diversity and are committed to fostering an inclusive workplace where all employees feel valued and empowered regardless of any characteristic protected by federal, state or local law including, without limitation, race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, medical condition, disability, age, marital status, or veteran status. Innovaccer Inc. participates in the E-Verify program to confirm employment eligibility of all newly hired employees based out of the U.S. and employed by Innovaccer Inc.

For any additional information, please visit the below websites:

E-Verify

Right to Work (English)

Right to Work (Spanish)

Disclaimer

Innovaccer does not charge fees or require payment from individuals or agencies for securing employment with us. We do not guarantee job spots or engage in any financial transactions related to employment. If you encounter any posts or requests asking for payment or personal information, we strongly advise you to report them immediately to our HR department at [e-mail]. Additionally, please exercise caution and verify the authenticity of any requests before disclosing personal and confidential information, including bank account details.