Medical Claims Appeals Specialist

The Addison Group; Addison (TX); On-site; USD 32,000 - 40,000; Full time

Benefits offered by this job

Modern, tech-focused office

Coffee stations

Massage chairs

Catered lunches twice per week

Comfortable break rooms

Job summary

The Addison Group is hiring an experienced Arbitration Specialist for a growing healthcare organization specializing in medical billing and revenue cycle management. This role is ideal for a detail-oriented professional who investigates complex claims, researches reimbursement discrepancies, and develops strategies to maximize collections.

The position focuses on evaluating claims, identifying underlying payment issues, and preparing well-supported appeals and reconsiderations.

Qualifications

• At least 2 years of experience in medical billing, healthcare accounts receivable, claims follow-up, denial management, appeals, or revenue cycle operations.
• Ability to interpret EOBs, ERAs, denial codes, payer communications, and payment discrepancies.
• Excellent organization, attention to detail, written communication, and follow-through.
• Familiarity with medical billing software, insurance portals, Microsoft Excel, and Outlook.
• Knowledge of HIPAA guidelines and healthcare billing compliance standards.

Responsibilities

• Oversee complex accounts receivable accounts involving denials, underpayments, aging balances, and unresolved payer disputes.
• Review EOBs, ERAs, payer communications, claim histories, and guidelines to identify discrepancies.
• Draft, submit, and monitor appeals, reconsiderations, corrected claims, and supporting documentation while meeting payer deadlines.
• Research claim issues involving prior authorization, insurance eligibility, medical necessity, coding, modifiers, filing limits, and payment discrepancies.
• Partner with internal teams to resolve challenging account issues.
• Evaluate denial patterns and payer trends to improve reimbursement and share recommendations with leadership.
• Maintain complete records of claim research, appeal documentation, payer interactions, submission timelines, and outcomes.

Skills

Medical billing

Denial management

Appeals

Revenue cycle

Accounts receivable

Claims follow-up

Tools

Microsoft Excel

Outlook

Availity

Clearinghouse platforms

Job description

The Addison Group is hiring an experienced Arbitration Specialist for a growing healthcare organization specializing in medical billing and revenue cycle management. This role is ideal for a detail-oriented professional who investigates complex claims, researches reimbursement discrepancies, and develops strategies to maximize collections.

The position focuses on evaluating claims, identifying underlying payment issues, and preparing well-supported appeals and reconsiderations.