Strategic Claims Denial & Appeals Specialist

Orthopaedic-Associates-of-Michigan; Grand Rapids (MI); On-site; USD 42,000 - 56,000; Full time

Job summary

Orthopaedic Associates of Michigan is seeking a Claims Denial & Appeals Specialist to review denied or underpaid insurance claims and prepare appeals. Position located in Grand Rapids, MI with standard 40-hour weeks, M-F 7-5.

You will work with carriers, patients, and internal teams to improve reimbursement outcomes and ensure HIPAA compliance. The role requires 1+ year in medical billing or related field, knowledge of CPT/ICD-10-CM/HCPCS, and proficient use of MS Office.

Qualifications

• High school diploma or equivalent required.
• 1+ year in medical billing, insurance appeals, AR or revenue cycle.
• Knowledge of CPT/ICD-10-CM/HCPCS and modifiers.
• HIPAA knowledge and confidentiality.

Responsibilities

• Review denied claims and determine appeal/action.
• Gather documentation for appeals and resubmit claims.
• Communicate with payers about denials and status.
• Audit accounts for payments, balances and codes.
• Monitor reimbursement activity and report variances.
• Identify denial trends and suggest improvements.
• Assist with patient financial counseling and arrangements.
• Maintain payer portals and security of credentials.

Skills

Communication skills

Customer service

MS Office

Analytical thinking

Multitasking

Organization

Interpersonal skills

Confidentiality

Payer guidelines

Adaptability

Education

High school diploma

College coursework (preferred)

Tools

Accounting systems

Remittance processing

Payer portal management

Job description

Orthopaedic Associates of Michigan is seeking a Claims Denial & Appeals Specialist to review denied or underpaid insurance claims and prepare appeals. Position located in Grand Rapids, MI with standard 40-hour weeks, M-F 7-5.

You will work with carriers, patients, and internal teams to improve reimbursement outcomes and ensure HIPAA compliance. The role requires 1+ year in medical billing or related field, knowledge of CPT/ICD-10-CM/HCPCS, and proficient use of MS Office.