Medical Biller - Denial Resolution Specialist

Job Summary

Community Clinic is seeking an experienced medical claims processor to join our team as a Denial Resolution Specialist. This person will be responsible for the investigation and resolution of denied claims and will take a lead role in overseeing the revenue cycle process from a claims and billing perspective. This is a full-time M-F position. 2+ years of experience in medical billing, coding, or revenue cycle management required. Certifications (e.g. CPC, CRCR, CHFP) preferred.

Key Responsibilities 

• Investigates, resolves, and appeals complex claim denials, including medical necessity, authorization, and coordination of benefits issues.
• Prepares and submits clean claims to third-party payers electronically or via paper.
• Manages payer follow-ups for outstanding and denied claims, ensuring resolution within compliance timeframes.
• Issues adjusted, corrected, and rebilled claims as needed to facilitate accurate reimbursement.
• Works closely with coding, revenue allocation, operations and patient accounting teams to ensure accurate claims processing.
• Investigates and resolves payer and clearinghouse claim rejections.
• Assists with inquiries and patient billing issues, ensuring clear and professional communication.
• Documents all denial resolutions and appeals activity accurately.
• Identifies denial and rejection trends, recommends corrective actions, and collaborates with leadership to reduce future denials and rejections.
• Mentors, trains and supports staff in understanding denial resolution and payer requirements.
• Assists with miscellaneous medical claims projects, staff coverage, peer reviews, and other tasks as needed.

Qualifications

• High school diploma or equivalent required.
• At least two years of experience in medical claims processing, denial resolution, and appeals required.
• Certifications in medical billing, coding, or revenue cycle management preferred (e.g., CPC, CRCR, CHFP).
• Experience in a Federally Qualified Health Center (FQHC) preferred.
• Extensive experience in professional billing, denial resolution, and appeals.
• Strong knowledge of eCW, medical billing systems, and clearinghouses.
• Familiarity with CPT, HCPCS, ICD-10 coding, revenue codes, occurrence codes, condition codes and common payer guidelines.

Why Join Community Clinic? 

• Be a part of a mission driven organization providing comprehensive health care to everyone in your community, regardless of their financial or medical situation!
• Automatic 5% contribution to employee retirement plan, no match required!
• Competitive pay, time-off, and 10 annual paid holidays!