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

Stout•Chicago, DC

About The Position

The Associate investigates complex hospital and health plan claims, tracing accounts through billing, claim submission, adjudication, payment, denial, and appeal. The role identifies reimbursement and pricing discrepancies, researches claim denials, and turns 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 position analyzes claims and reimbursement using contract terms, rate schedules, payment methodologies, claim transactions, payer policies, coding guidance, medical records, and appeal correspondence. It quantifies disputed amounts, prepares claim timelines and supporting exhibits, maintains organized workpapers, and quality-checks analyses and written deliverables. The Associate collaborates with healthcare revenue cycle and managed care teams, health plan operations, coding and clinical specialists, counsel, and Stout engagement leaders or managers. The role requires a relevant bachelor's degree or equivalent directly relevant experience and at least three years of hands-on experience in healthcare claims or revenue cycle work. Stout describes a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options, as well as training, mentorship, employee resource groups, performance feedback, flexible work schedules, and a discretionary time off policy. The estimated annual compensation range is $74,000–$135,000, and the role is anticipated to be eligible for an annual bonus plan.

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 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.
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 and 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 claim history.
Investigate pricing and reimbursement discrepancies by comparing billed charges, payer contract terms, rate schedules, expected allowed amounts, and actual payments; identify incorrect rates, adjustments, and payment logic.
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; distinguish administrative, contractual, and clinical issues.
Evaluate disputed claims involving coding, medical necessity, prior authorization, eligibility, coverage, timely filing, DRG downgrades, and recoupments, coordinating with clinical or coding specialists when appropriate.
Quantify underpayments and other disputed amounts; prepare claim timelines, pricing variance analyses, issue summaries, and exhibits with independently verifiable calculations.
Draft evidence-based investigative narratives, claim dispute reports, reconsideration requests, and appeal letters that connect findings to claim records, contract language, and other supporting evidence.
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 claim 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; demonstrate analytical rigor, professional integrity, and exceptional client service.