Healthcare Claims Denials & Edits Specialist

CorroHealth, Inc.; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

CorroHealth, Inc. in the United States seeks an AR Specialist to ensure timely collections of government or commercial healthcare insurance receivables. The AR Specialist follows up on outstanding accounts across payer types, including self-pay and denial resolutions.

Reporting to the Manager, AR Services, you will verify eligibility, obtain authorizations, analyze EOBs, prepare appeals, and interact with payers to secure payments while maintaining accuracy in client systems.

Qualifications

• 3+ years of accounts receivable experience within the healthcare revenue cycle.
• Must have a minimum of 2 years’ experience with Medi-Cal.
• 2+ years of experience with healthcare and/or insurance billing and processing.
• Experience with professional physician and hospital facility claims.
• Ability to read and interpret an EOB.
• Knowledge and understanding of UB04 and HCFA 1500 forms.
• High School diploma
• Proficiency with Outlook, Excel, and Word; able to manage email, calendar and basic formulas.
• Ability to communicate in a professional and clear manner.
• Strong interpersonal skills
• Ability to work independently, with analytical and critical thinking skills.

Responsibilities

• Interact with insurance plans, patients, physicians, attorneys, and team members to resolve claims.
• Verify patient eligibility and obtain authorizations by payer websites, client systems, or phone.
• Update patient demographics and insurance information in appropriate systems.
• Research and status unpaid or denied claims.
• Monitor claims for missing information, authorization and control numbers.
• Research EOBs for payments/adjustments to resolve claims.
• Contact payers by phone or mail to secure payment.
• Access client systems for payments, open claims and data to resolve claims.
• Follow prioritization, timely filing deadlines, and notation protocols.
• Secure medical documentation as required by carriers.
• Obtain billing guidelines by researching provider manuals.
• Write appeal letters for technical appeals.
• Verify underpayments by researching contracts/claims.
• Prepare claims for clinical audit processing when denials occur.

Skills

AR experience

Medi-Cal experience

Healthcare billing

Professional claims

EOB interpretation

UB-04/HCFA-1500 forms

Outlook & Excel

Communication

Interpersonal skills

Analytical thinking

Independence

Education

High School diploma

Tools

Outlook

Excel

Word

Job description

CorroHealth, Inc. in the United States seeks an AR Specialist to ensure timely collections of government or commercial healthcare insurance receivables. The AR Specialist follows up on outstanding accounts across payer types, including self-pay and denial resolutions.

Reporting to the Manager, AR Services, you will verify eligibility, obtain authorizations, analyze EOBs, prepare appeals, and interact with payers to secure payments while maintaining accuracy in client systems.