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Acute Wound Care

Clinical Claim & Appeal Specialist

Entry-Level JobVerifiedNo experience needed

Career Insights for Claims Adjuster / Specialist (General)

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Based on Florida data

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What they do

A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.

$70,444 / year median in Florida

+6% projected growth

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Job Description

Claims & Accounts Receivable Specialist Join Our Growing Team Acute Wound Care is a growing Florida-based healthcare company dedicated to helping patients receive the medical equipment and services they need to improve their quality of life. We specialize in advanced compression therapy and wound care solutions and work with patients, physicians, insurance carriers, and healthcare partners throughout Florida. We are looking for a motivated and detail-oriented Claims & Accounts Receivable Specialist to join our reimbursement team. This position has a strong focus on Accounts Receivable management, accurate payment posting, and resolving outstanding claims. The ideal candidate enjoys researching claims, solving reimbursement issues, and taking ownership of Accounts Receivable from payment review through final resolution. Key ResponsibilitiesAccounts Receivable & Payment Management Manage and actively work assigned Accounts Receivable. Post and review all incoming insurance payments. Review EOBs and ERAs to ensure payments and adjustments are posted accurately. Identify and work unpaid and underpaid claims. Research payment discrepancies and take the appropriate action to obtain correct reimbursement. Follow outstanding claims through payment or final resolution. Recoupments Post and review insurance carrier recoupments. Research recoupments to determine whether they are valid. Identify and work improper recoupments . Submit disputes, reconsiderations, or supporting documentation when appropriate. Track recoupments through final resolution. Rejections & Denials Review and work rejected claims promptly. Identify rejection reasons, make necessary corrections, and resubmit claims. Work with Brightree to establish a rejection report for routine monitoring. Review and work insurance denials and payment discrepancies. Determine the appropriate next step, including corrected claims, reconsiderations, appeals, medical records, or payer follow-up. Escalate recurring or unresolved payer issues when necessary. Claim Task Management Maintain accurate and up-to-date claim tasks. Document the date of each denial, rejection, or payment issue . Clearly document actions taken and the next step required . Set appropriate follow-up dates and continue working claims until resolved. Close completed tasks promptly so the AR workload accurately reflects outstanding claims. Payment & EOB Documentation Create and maintain an organized server folder for PaySpan and other electronic payment documentation . Save EOBs, ERAs, payment confirmations, recoupment notices, and copies of payments. Maintain organized documentation that can be easily accessed when researching claims or reconciling Accounts Receivable. What We're Looking For Experience with medical billing, insurance claims, reimbursement, or Accounts Receivable preferred. Strong understanding of EOBs, ERAs, denials, rejections, and insurance payments. Excellent attention to detail and organizational skills. Strong research and problem-solving abilities. Ability to independently manage claims through resolution. Comfortable communicating with insurance carriers and researching reimbursement issues. Experience with Brightree is a plus. Positive, dependable, and team-oriented. Benefits PTO & Paid Holidays Health & Dental Insurance 401(k) with Employer Match Why Join Acute Wound Care? Join a growing healthcare company where your work makes a meaningful difference for both our patients and our organization . You'll be part of a supportive team that values accuracy, accountability, problem-solving, and employees who take initiative. This role directly impacts our patients by helping ensure they receive the insurance coverage and benefits available to them for their claims . As Acute Wound Care continues to grow throughout Florida, you'll have the opportunity to grow with the company while playing an important role in strengthening and improving our reimbursement processes.
Job Type:
Full-time Pay:
$20.00 - $23.00 per hour
Benefits:
401(k) Health insurance Paid time off
Work Location:
Hybrid remote in Bonita Springs, FL 34135