Remote 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

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.