Job Summary
We're looking for an experienced A/R professional who excels at resolving denied, underpaid, and aged claims not just tracking them. This person will own a portfolio of accounts, dig into root causes of non-payment, and drive claims to resolution through appeals, corrections, and direct payer negotiation. Ideal for someone who treats every denial as a puzzle to solve, not a box to check.
Key Responsibilities
- Take ownership of a claims/account and drive resolution to $0 balance — not just documented follow-up
- Resolve a high daily volume of denials, balancing speed with accuracy and long-term recovery rate
- Analyze denial codes and EOBs/ERAs to identify root cause (coding error, eligibility issue, timely filing, medical necessity, bundling, etc.)
- Draft and submit appeals with supporting documentation for denied or underpaid claims
- Negotiate directly with insurance payers/adjusters to resolve payment disputes
- Correct and resubmit claims (coding corrections, COB updates, missing info) with a high first-pass resolution rate
- Identify denial trends and root causes, and recommend upstream process fixes to prevent recurrence
- Prioritize high-dollar and high-risk aged accounts to minimize write-offs
- Escalate only what truly needs escalation — resolve the rest independently
- Track and report daily on volume resolved, resolution rate, and recovered dollars
- Stay current on payer policy changes, timely filing limits, and appeals processes
Required Qualifications
- 3+ years of hands-on experience resolving (not just following up on) insurance claims
- Proven track record of successfully appealing and overturning denials
- Strong working knowledge of denial codes (CARC/RARC), EOBs/ERAs, and payer adjudication
- Experience with claims scrubbers, clearinghouses, and payer portals
- Ability to read a denial and know the fix — not just log it and wait
- Excellent written communication for appeals and payer correspondence
- Ability to work efficiently at high volume without sacrificing accuracy or overturn rate
Preferred Qualifications
- Experience across multiple payer types (Medicare, Medicaid, commercial, workers comp)
- Background in high-volume or complex specialty billing
- Analytical, root-cause problem-solving
- Persistence and follow-through on multi-step appeals
- High attention to detail under volume pressure
- Self-directed — flags patterns instead of just processing claims
Compensation & Work Location
Pay: 70-80K (depending on experience level)
Location: Onsite — office-based position (Ormoc , Leyte), no remote/work-from-home option
