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Claims Specialist / Adjuster / Examiner
Altamonte Springs, FL
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POSITION OFFERED BY A NO FEE STAFFING AGENCY
Job Requirements:
1+ year of experience in healthcare billing, medical billing, revenue cycle, insurance collections, or denial management. Experience working with insurance claims, claims follow-up, appeals, reconsiderations, and healthcare reimbursement (not traditional patient/call center collections). Experience with CPT, ICD-10, and HCPCS codes. Experience with 837I and/or 837P claim formats, as well as UB-04 and/or
CMS-1500
claim forms. Experience specifically related to behavioral health, mental health, or substance abuse billing strongly preferred. Understanding of insurance reimbursement guidelines, payer requirements, insurance verification, and ability to read/interpret medical records and policies. Ability to research denials, determine appropriate next steps, and follow accounts through to resolution. Strong written and verbal communication skills, including comfort communicating with insurance companies by phone, using payer portals, and preparing written appeals. Excellent attention to detail, organization, and time-management skills to effectively manage a high-volume workload.
Job Responsibilities:
Denials Analysis & Resolution:
Review and analyze EOBs, denial letters, and claim information to identify root causes (e.g., coding, eligibility, medical necessity, NPI/taxonomy errors, missing documentation). Verify claim accuracy, correct discrepancies, and resubmit corrected claims.
Appeals & Reconsiderations:
Gather medical records and supporting documentation to draft, submit, and follow up on clear, payer-specific appeal letters within strict deadlines. Contact insurers via phone or portals to request reconsiderations and resolve disputed claims.
Claim Tracking & Account Resolution:
Monitor claims, appeals, takebacks, and recoupments through final resolution while maintaining detailed, accurate documentation of calls, portal activity, and outcomes.
Process Improvement & Targets:
Identify recurring denial trends to support prevention strategies, working toward a monthly production goal of 800-1,000 claims and contributing to $1.5 million in annual AR recovery.
Cross-Departmental Collaboration:
Work closely with Billing, BOS, UR, and other internal departments to address complex reimbursement issues and escalate unresolved accounts to management when necessary.
Compliance & Professional Communication:
Communicate professionally with insurance representatives and ensure all work adheres to federal, state, Medicare, Medicaid, and commercial payer regulations.
