Denials & AR Recovery Specialist

Mochi Health; San Francisco (CA); In loco; USD 80.000 - 100.000; Tempo pieno

Descrizione del lavoro

Mochi Health Corp. in San Francisco, CA is seeking an Denials & AR Recovery Specialist to own the recovery of insurance revenue that doesn’t pay on the first pass. You will handle denied and underpaid claims, file payer appeals, and track aging AR to improve cash collection.

This is an in-person role based in our SF office. You will work with the coding and billing teams to identify denial patterns and implement upstream fixes, while ensuring HIPAA compliance and accurate documentation.

Competenze

• 2+ years of medical billing, denials, or AR follow-up experience.
• Ability to read remittances and act on CARC/RARC denial codes.
• Familiarity with payer portals, clearinghouses, and billing or practice-management systems.
• Strong written communication for appeal letters, and persistence and attention to detail under deadline pressure.
• High school diploma or equivalent.

Mansioni

• Denial resolution and appeals: manage denied, rejected, and underpaid claims with timely filings.
• AR follow-up: monitor aging AR and pursue underpayments.
• Root-cause and prevention: categorize denials and surface top recurring drivers.
• Reporting and documentation: log activity and outcomes in the billing system and report metrics.
• Compliance and privacy: HIPAA adherence and safeguards.

Conoscenze

Medical billing

AR follow-up

Denials management

Attention to detail

Written communication

Formazione

High school diploma

Associate degree

Bachelor's degree

CPB (AAPC)

CRCR (HFMA)

CPC

Strumenti

Payer portals

Clearinghouses

Billing systems

Spreadsheets

Descrizione del lavoro

Healthcare is broken at the first step: patients can't find the right care, understand what it costs, or access the medications they need. Mochi Health is fixing this.

We're building an AI-driven marketplace that makes healthcare discoverable—connecting patients to the right providers, transparent pharmacy pricing, and affordable medications. Over the past few years, we've grown rapidly by combining clinical expertise with technology that actually works for real people, not just hospital systems.

Our platform does what legacy healthcare can't: it gives patients transparent pricing before they pay, personalized medication management that follows them across providers, and long-term access to their own medical records. We're proving that healthcare can be more affordable, more human, and far more intuitive than what exists today.

Join a team that's rebuilding healthcare from the patient up. At Mochi Health, you'll work alongside people who value bold thinking, inclusive collaboration, and getting meaningful work into the world. If you want to do the most impactful work of your career, this is where to do it.

About the role

We are a fast-growing telehealth company building out a dedicated insurance team to keep pace with rapid patient growth. Today our billing and coding is handled in-house with a strong front-end review process. As claim volume scales, we need a dedicated owner for the back end of the revenue cycle: the claims that come back denied, rejected, underpaid, or stuck with the payer.

The Denials & AR Recovery Specialist owns the recovery of insurance revenue that does not get paid cleanly on the first pass. You will work denied and underpaid claims to resolution, file appeals within payer deadlines, follow up on aging accounts receivable, and feed denial patterns back to the coding team so preventable denials stop at the source. This is a hands‑on, metrics‑driven role with a direct and measurable impact on cash collected.

What you will do

Denial resolution and appeals:

• Work daily queues of denied, rejected, and underpaid claims, prioritizing by dollar value and by timely‑filing and appeal deadlines.
• Review remittances (ERAs and EOBs) and interpret CARC and RARC denial codes to determine the true root cause of each denial.
• Prepare and submit payer‑compliant appeals supported by clinical documentation, medical necessity rationale, and payer policy or contract language.
• Correct and resubmit claims where the issue is a billing, coding, demographic, or eligibility error, routing coding questions to the coding team.
• Track every claim through to resolution rather than resubmitting and moving on.

Accounts receivable follow‑up

• Monitor and work aging AR, following up with payers by portal, phone, and written correspondence until accounts are resolved.
• Identify and pursue underpayments against expected allowed amounts and contracted rates.
• Escalate systemic payer issues (recurring denials, payer processing errors, contract disputes) to the RCM Lead with supporting data.

Root‑cause and prevention

• Categorize denials by reason, payer, provider, and CPT code, and surface the top recurring drivers each month.
• Partner with the coding and billing team to fix denial causes upstream, so the first‑pass clean‑claim rate improves as volume grows.
• Flag any coding or documentation patterns that could create compliance or audit exposure, including E&M level and modifier issues.

Reporting and documentation

• Document all activity, notes, and outcomes in the billing system accurately and in real time.
• Report on denial rate, denial dollars recovered, appeal success rate, and days in AR, and contribute to weekly team reviews.
• Maintain patient and health information in line with HIPAA and company privacy and security policies.

What we are looking for

Required:

• 2+ years of medical billing, claims, denials, or AR follow‑up experience, ideally including commercial payer appeals.
• Working knowledge of the full revenue cycle and of CPT, ICD‑10, and HCPCS coding concepts (you do not need to be a coder, but you must read and reason about claims).
• Ability to read remittances and act on CARC/RARC denial codes, knowing the correct next step for each (appeal, correct and resubmit, write off, escalate).
• Familiarity with payer portals, clearinghouses, and billing or practice‑management systems.
• Comfort with spreadsheets for tracking, prioritizing, and reporting on claim work.
• Strong written communication for appeal letters, and persistence and attention to detail under deadline pressure.
• High school diploma or equivalent.

Preferred:

• Experience in telehealth, primary care, or a high‑volume E&M billing environment.
• A billing or revenue cycle credential such as CPB (AAPC) or CRCR (HFMA); a coding credential (CPC) is a plus for coding‑related denials.
• Associate or bachelor's degree in healthcare administration, business, or a related field.
• Experience identifying denial trends and driving upstream process fixes, not just reworking claims.

How we will measure success

In the first 90 days you will ramp on our payers, systems, and denial mix. Ongoing success is measured by:

• Denial dollars recovered and appeal overturn rate.
• Reduction in days in AR and in the aged AR backlog.
• A falling first‑pass denial rate, driven by the prevention patterns you surface to the coding team.
• Timely‑filing and appeal deadlines consistently met, with no revenue lost to missed windows.

Working here

This is an in‑person role based in our office. You will sit alongside the coding and billing team, which is what makes the prevention loop work: denials you resolve translate directly into cleaner claims going out the door. As the insurance team grows, strong performers in this role are well positioned to specialize further or to move into a senior or lead denials position.

Compensation

Annual Compensation for this role is $80,000 - $100,000

Workplace Policy

Mochi Health is an in‑person company based in San Francisco, CA. Our team works together in person five days a week to foster collaboration, innovation, and strong connections. We believe that face‑to‑face interaction builds a culture of excellence and allows us to deliver the best outcomes for the patients and providers we serve.

Candidate Privacy Notice

Please review Mochi Health's Candidate Privacy Notice here .

Accommodations

Mochi Health complies with the Americans with Disabilities Act (ADA), as amended by the ADA Amendments Act, and all applicable state or local laws. We will reasonably accommodate qualified individuals with a disability during the application process and throughout employment as required by law.

If you need any assistance or accommodations due to a disability, please contact us at [e-mail].