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Candidates must be able to work on-site. This position is not remote. GENERAL PURPOSE OF JOB: The Claims and Appeals Specialist II is a certified medical coder that performs audits for correct coding and claims payments and oversees the claims appeal process for provider and member appeals. This position also investigates Coordination of Benefit (COB) claims. The Claims and Appeals Specialist II reports to the Director of Claims Oversight. ESSENTIAL DUTIES AND RESPONSIBILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate...

Position Overview We are seeking an experienced Billing Specialist to join our busy infertility practice. The ideal candidate is preferred to have billing experience in women's health care. This role requires strong knowledge of medical billing workflows, insurance follow-up, denial management, payment posting, claims resolution, and patient account management specific to women’s health. Key Responsibilities   Submit clean claims accurately and timely through our EMR system  Review and resolve claim rejections and denials across all insurance platforms  Follow up with insurance companies on unpaid claims  Post insurance and patient payments accurately in our EMR system  Work aging reports and outstanding AR  Review patient accounts for billing accuracy and follow-up needs  Handle billing corrections, resubmissions, and appeals  Communicate with registration/front desk, clinical staff, and management to resolve   billing issues  Maintain compliance with...

About the Role: The Accounts Receivable Specialist (“Specialist”) is an integral member of Community Reach Center’s Finance (“Division”) Division. The Specialist is responsible complete billing process including timely and accurate review of the billing and reporting including data analysis and follow-up and records payments to Consumer/Patient accounts and maintains accounts receivable records. Additionally, the Specialist will have other duties and responsibilities as determined from time to time by the Accounts Receivable Manager. Essential Functions:  Conducts agency business and engages both internal and external customers in a professional and collaborative manner. Accurately post payments to account including apply notations to account for communication. Responsible for follow-up, appeals and denials of claims. Complete insurance eligibility and benefit verification. Regularly work aging and unbilled reports for payment. Reviews all intake and...

This in on-site role  Job Summary The Billing Specialist II plays a key role in ensuring the success of the revenue cycle by managing billing functions, resolving denials, and supporting process improvements. This position serves as a resource for training, special projects, and complex billing issues, with a strong focus on accuracy, compliance, and timely claims resolution. Key Responsibilities: Duties include, but are not limited to: ·         Identify, research, and resolve complex claims, including payer-rejected and denied claims . ·         Investigate denial reasons and develop strategies to reduce future occurrences . ·         Prioritize and resolve items in billing and manager hold buckets . ·         Verify insurance coverage and eligibility, update patient records with accurate information . ·         Manage accounts receivable and follow up on outstanding balances . ·         Collaborate with...

Account Specialist II Locations: Fort Worth, TX Time type: Full time Job requisition id: JR-114239 Location: Calmont Operations Building Department: CBO/Patient Financial Services Shift: First Shift (United States of America) Standard Weekly Hours: 40 Summary: Under the leadership of Patient Financial Services (PFS) management, the Account Specialist II is responsible for accounts receivable through claim follow up, cash collection, and denial management for services rendered by Cook Children's Medical Center (CCMC). This position requires extensive knowledge of Federal, State, and payor regulations, reimbursement methodologies, and communication with third party payers to facilitate timely and accurate reimbursement. Perform root cause analysis and resolution of denial and variance records. Triage and resolve payor denials. Review and adjudicate insurance credit balances. Qualifications: High School Diploma or...

Champion Accurate Coding. Win Appeals. Make an Impact. Primarily Remote | Monthly Onsite   Love the challenge of proving you’re right? This role is for coders who don’t just assign codes — they defend them. You’ll be part of a team that ensures providers are paid accurately for the care they deliver. When a payer says no, you build the case that turns it into yes. Your coding expertise, clinical insight, and persistence directly impact reimbursement and provider success.   What makes this role exciting You’ll advocate for correct payment, not just code charts Your work directly reverses denials and underpayments You’ll collaborate with physicians, payers, and fellow coding experts Every appeal you win is a tangible victory   What you’ll do Review medical records to validate accurate ICD‑10, CPT, and HCPCS coding Identify documentation or coding issues that impact reimbursement Build, submit, and follow payer...