Associate, Healthcare Revenue Cycle Specialist – Disputes, Claims & Investigations

Stout • Washington, DC

1d • $74,000 - $135,000

About The Position

The Associate investigates complex hospital and health plan claims to trace how accounts move through billing, claim submission, adjudication, payment, denial, and appeal. The role identifies reimbursement and pricing discrepancies, researches denial reasons, and converts detailed evidence into investigative reports and appeal narratives. The Associate works with senior consultants and experts to develop evidence-based analyses for payor-provider disputes, including matters involving formal appeals or litigation.

The role includes analyzing claim histories and reimbursement terms, reviewing claim records and transaction data, evaluating coding, clinical, contractual, and administrative issues, and quantifying disputed amounts. It also involves preparing claim timelines, pricing analyses, reports, exhibits, reconsideration requests, and appeal letters. The Associate collaborates with hospital revenue cycle and managed care teams, health plan operations, coding specialists, clinicians, counsel, and Stout engagement leaders and managers.

The successful candidate takes ownership of investigations, maintains clear workpapers and an audit trail, produces accurate and well-supported deliverables, communicates open questions and deadlines, and exercises sound judgment and discretion when handling protected health information. Stout describes its culture as centered on Relentless Excellence and values including teamwork, accountability, commitment, relationship focus, responsiveness, and communication.

Requirements

• Bachelor's degree in Accounting, Finance, Health Information Management, Healthcare Administration, Business, or a related field; equivalent directly relevant experience may be considered.
• At least 3 years of hands-on experience in hospital revenue cycle, reimbursement analysis, health plan claims operations, denials management, payment variance investigations, or provider appeals.
• Deep working knowledge of hospital and payer claims workflows, including claim creation, edits, adjudication, contractual payment, payment posting, denial resolution, and multiple levels of appeal.
• Experience evaluating contractual reimbursement and pricing variances for commercial, Medicare, or Medicaid claims, with an understanding of inpatient and outpatient payment methodologies.
• Ability to interpret institutional and professional claims, 837/835 transactions, EOBs/ERAs, CARC/RARC codes, CPT/HCPCS, ICD-10, revenue codes, modifiers, and DRG/APR-DRG/APC concepts.
• Demonstrated ability to research denial reasons, assess supporting billing and clinical documentation, and write clear, fact-based dispute narratives or payer appeal submissions.
• Advanced Excel skills.
• Strong written communication skills.
• Sound investigative judgment, careful documentation, discretion in handling protected health information, and ability to manage time-sensitive engagement deadlines.

Nice To Haves

• SQL proficiency or experience with hospital billing and health plan claims platforms.
• Relevant certifications such as CRCR, CHFP, CPC, CCS, RHIA, or RHIT.
• Experience working with multidisciplinary healthcare or dispute teams.

Responsibilities

• Trace disputed hospital and health plan claims through coding, billing, submission, payer edits, adjudication, payment posting, denials, recoupments, and appeals to establish the claim history.
• Investigate pricing and reimbursement discrepancies by comparing billed charges, payer contract terms, rate schedules, expected allowed amounts, and actual payments.
• Interpret provider agreements, reimbursement policies, and inpatient and outpatient payment methods, including DRG/APR-DRG, APC, case rates, fee schedules, and contractual carve-outs.
• Review UB-04/CMS-1450 and CMS-1500 claims, 837/835 transactions, explanations of benefits, remittance advices, account notes, and payment histories to reconcile claim-level evidence.
• Research denial and adjustment reasons using CARC/RARC codes, payer policies, coding guidance, denial letters, medical records, and prior appeal correspondence.
• Evaluate disputed claims involving coding, medical necessity, prior authorization, eligibility, coverage, timely filing, DRG downgrades, and recoupments; coordinate with clinical or coding specialists when appropriate.
• Quantify underpayments and other disputed amounts and prepare claim timelines, pricing variance analyses, issue summaries, and independently verifiable exhibits.
• Draft evidence-based investigative narratives, claim dispute reports, reconsideration requests, and appeal letters for payor-provider disputes.
• Work with hospital revenue cycle and managed care teams, health plan operations, coding specialists, clinicians, counsel, and Stout engagement leaders and/or managers to resolve factual gaps and support dispute strategies.
• Analyze claims populations in Excel, SQL, or other tools to identify patterns of denials and payment errors.
• Maintain organized workpapers and quality-check analyses and written deliverables.
• Take ownership of assigned investigations, maintain a clear audit trail, and deliver accurate, well-supported work on time.
• Communicate missing documentation, competing interpretations, and appeal deadlines early so the team can address them.
• Learn payer rules, reimbursement methods, and claims systems, and demonstrate analytical rigor, professional integrity, and exceptional client service.

Benefits

• Comprehensive Total Rewards program with competitive compensation, benefits, and wellness options.
• Ongoing training and mentorship.
• Employee resource groups and clear performance feedback.
• Flexible work schedules.
• Discretionary time off policy.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level