Revenue Cycle Execution Specialist – Denials & Appeals

Alicohealthcare; Boston (MA); Remote; USD 55,000 - 75,000; Full time

Job summary

Alico Healthcare is seeking a Revenue Cycle Specialist to support claim submissions, follow up on denials, and manage accounts receivable.

You will review claims, correct rejections, communicate with payers, document actions, and escalate complex issues per client requirements and Alico’s procedures. Remote role limited to MA, FL, or NC residents with prior medical billing experience.

Qualifications

• At least two years of hands-on experience in medical billing, denial management, insurance follow-up, or accounts receivable.
• Experience using electronic health record or practice management systems, payer portals, and clearinghouse tools.
• Ability to distinguish claim rejections from denials and know when a document, appeal, or follow-up is needed.
• Knowledge of remittance information, contractual adjustments, patient responsibility, and filing or appeal deadlines.
• Clear written notes and professional communication via phone and email.

Responsibilities

• Review claims and billing information. Check for missing or inconsistent data and coordinate corrections before submission.
• Work clearinghouse and payer rejections. Review details, make corrections, resubmit, and confirm status.
• Investigate denials and payment discrepancies. Review payer explanations, account history and docs; prepare or coordinate appeals and escalate when needed.
• Manage assigned receivables. Prioritize follow-up by balance, deadlines, and actions; contact payers and coordinate with internal staff.
• Review remittance information and document progress; interpret EOBs and note what's established and what remains.
• Use approved systems responsibly. Work within EHR/PM systems, payer portals, and clearinghouse tools; report recurring issues and ensure privacy.

Skills

Medical Billing

Denials & Appeals

Accounts Receivable

Payer Communications

Tools

EHR/PM Systems

Payer Portals

Clearinghouse Tools

Job description

Revenue Cycle Execution Specialist – Denials & Appeals

Description

Alico Healthcare is seeking a Revenue Cycle Specialist to support claim submission, rejection correction, denial follow-up, and accounts receivable.

You will review assigned accounts, determine why payment remains unresolved, and carry out the appropriate next action within the client’s requirements and Alico’s procedures. The position requires accurate documentation, professional payer communication, and the ability to distinguish routine follow-up from an issue that needs escalation.

Assignments may cover different healthcare organizations and systems. The specific mix of billing, payment review, and follow-up responsibilities will depend on the accounts assigned.

Responsibilities

• Review claims and billing information. Check assigned claims for missing or inconsistent information and coordinate necessary corrections before submission.
• Work clearinghouse and payer rejections. Review rejection details, make authorized corrections, resubmit as appropriate, and confirm the resulting submission status.
• Investigate denials and payment discrepancies. Review payer explanations, account history, supporting documentation, and applicable requirements. Prepare or coordinate appeals and elevate issues that require additional approval or information.
• Manage assigned receivables. Prioritize follow-up using account status, balance, filing or appeal deadlines, and previous actions. Contact payers and coordinate with internal staff or client contacts as needed.
• Review remittance information and document progress. Interpret explanations of benefits and electronic remittance advice, identify unpaid or potentially underpaid balances, and record what was established, what remains outstanding, and the next action.
• Use approved systems responsibly. Work within client electronic health record and practice management systems, payer portals, and clearinghouse tools. Review information returned by automated workflows, report recurring issues, and follow privacy and confidentiality requirements.

Qualifications

• At least two years of hands-on experience in medical billing, denial management, insurance follow-up, or accounts receivable.
• Experience using electronic health record or practice management systems, payer portals, and clearinghouse tools.
• Ability to distinguish claim rejections from denials and understand when an account needs correction, additional documentation, an appeal, or further payer follow-up.
• Working knowledge of remittance information, contractual adjustments, patient responsibility, and filing or appeal deadlines.
• Clear written account notes, professional telephone and email communication, and the ability to manage an assigned workload without losing track of unresolved requirements.

Preferred qualifications

Experience supporting behavioral health, therapy, multidisciplinary practices, or other specialty services is useful. Familiarity with eligibility verification, authorization-related billing issues, and provider-enrollment issues is also helpful.

Spanish-language proficiency is welcome but is not a proposed requirement for this position.

Location: Remote (Strictly limited to MA, FL, or NC residents)