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Rcm reimbursement specialist focused on appeals and denials

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Robert Half

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Location:
United States , Houston

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Category:
Finance

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

We are seeking an experienced and detail‑oriented RCM Reimbursement Specialist focused on Appeals and Denials to join our team on a contract-to-hire basis. This fully remote role is essential in maximizing reimbursement by following up on outstanding insurance balances, resolving unpaid claims, and managing appeals through multiple levels. The ideal candidate thrives in a fast‑paced environment, is meticulous in their work, and has deep expertise in medical billing, payer processes, and denial management.

Job Responsibility:

  • Resolve aged claims and appeals lacking payer responses through payer portals and outbound calls
  • Identify claims requiring first, second, or third‑level appeals
  • Support teammates with special projects and denial work queue management
  • Prioritize an assigned work queue to ensure timely follow‑up while maximizing reimbursement opportunity
  • Identify non‑payment trends and partner with Revenue Cycle leadership to escalate groups of claims to Market Access
  • Investigate denial and non‑payment trends identified by Revenue Cycle Analytics and collaborate cross‑functionally to propose and implement solutions
  • Communicate opportunities to improve upstream processes that may prevent future denials
  • Engage patients when their involvement is required during the appeal process
  • Collaborate professionally with Revenue Cycle team members and respond promptly to requests requiring assistance

Requirements:

  • College degree preferred, or equivalent experience (5+ years)
  • Minimum 5 years of medical billing experience, with strong preference for candidates experienced in molecular laboratory billing
  • Understanding of HIPAA regulations and proper handling of PHI
  • Solid working knowledge of health insurance plans, reimbursement policies, and claims terminology
  • Strong communication and interpersonal skills
  • Highly meticulous with strong analytical and problem‑solving abilities
  • Strong knowledge of insurance guidelines, CPT/ICD‑10 coding, and medical terminology
  • Excellent attention to detail and time management
  • Effective communication and problem‑solving abilities
  • Proficiency in Microsoft Office Suite and healthcare billing software tools
What we offer:
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in our company 401(k) plan

Additional Information:

Job Posted:
February 20, 2026

Work Type:
Remote work
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