Claims Resolution Specialist

Boomerang Healthcare

Claims Resolution Specialist handling claim rejections, denials, and billing issues for healthcare organization. Collaborating with multiple teams for timely resolution and compliance.

Posted 7/10/2026full-timeRemote • Arizona, California, Nevada, New Mexico, Oregon, Texas, Washington • 🇺🇸 United StatesMid-LevelSenior💰 $28 - $35 per hourWebsite

About the role

Key responsibilities & impact

Investigate and resolve claim rejections, denials, and payer edits identified before or after claim submission
Review claim history, payer correspondence, medical records, authorizations, and supporting documentation to determine the cause of claim issues
Correct billing, coding, demographic, authorization, and insurance-related claim errors as appropriate
Process claim corrections, adjustments, resubmissions, and reconsideration requests in accordance with payer guidelines
Perform payer research and communicate directly with insurance carriers to resolve claim processing issues
Monitor assigned work queues and ensure timely resolution of outstanding claims
Escalate complex reimbursement, coding, or compliance issues to senior team members
Partner with A/R and Denials Management teams to resolve denied and underpaid claims
Assist in preparing appeal documentation and supporting materials for denied claims
Identify recurring denial patterns and communicate findings to the Senior Claims Resolution Coordinator
Maintain accurate documentation of denial resolution activities and payer communications
Support efforts to reduce preventable denials and improve reimbursement outcomes
Work closely with the pre-billing team to identify and correct claim issues prior to submission
Review claims for completeness and compliance with payer billing requirements
Verify insurance information, authorizations, referrals, diagnosis coding, procedure coding, and modifier usage
Collaborate with coding and clinical teams to obtain information needed for claim resolution
Assist with reducing claim holds and billing delays
Participate in routine claim quality reviews and internal audit activities
Ensure claim corrections comply with payer regulations, organizational policies, and billing guidelines
Support Revenue Integrity initiatives through accurate claim review and documentation
Maintain knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial payer requirements
Adhere to HIPAA, CMS, and organizational compliance standards
Maintain detailed documentation of claim investigations, resolutions, payer communications, and follow-up activities
Track assigned workloads and resolution outcomes
Assist with compiling information for denial trend reporting and operational reviews
Provide feedback regarding workflow issues contributing to claim errors or payment delays
Assumes other responsibilities as appropriate to the position and organizational needs

Requirements

What you’ll need

High School Diploma or equivalent required
Associate degree in Healthcare Administration, Medical Billing and Coding, or related field preferred
Minimum 2-4 years of experience in medical billing, claims resolution, denial management, accounts receivable, or healthcare revenue cycle operations
Working knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial insurance billing requirements
Knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical terminology
Experience researching and resolving denied or rejected claims
Strong analytical and critical thinking skills
Ability to manage multiple priorities and meet productivity expectations.

Benefits

Comp & perks

Amazing work/life balance
Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO)
401(K) Plan with Employer Matching
License & Tuition Reimbursements
Paid Time Off
Holiday Pay & Floating Holiday
Employee Perks and Discount Programs
Supportive environment to help you grow and succeed

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claims ProcessingBilling CorrectionsPayer ResearchAuthorization VerificationDenial Trend ReportingHealthcare Revenue Cycle OperationsMedical TerminologyModifier UsageCompliance StandardsAnalytical Skills

Soft Skills

Critical ThinkingTime ManagementCommunication Skills

Certifications

High School DiplomaAssociate Degree in Healthcare Administration