Claims Escalation & Denials Appeals Specialist

Northpoint Recovery Holdings, LLC • Meridian, ID

1d • $22 - $24 • Remote

About The Position

As a key member of the Revenue Cycle Management team, the Claims Escalation & Denials Appeals Specialist manages collection, denial resolution, and accounts receivable for assigned accounts. The specialist collects outstanding insurance balances for services provided to Northpoint patients and clients, working with patients, insurers, and Northpoint providers to secure timely payment. Payer denials and rejections are followed up through resolution or payment.

The position requires understanding the patient billing lifecycle, including verifications, pre-authorization, utilization review, appeals, claims submission and adjudication, and denials. It also requires knowledge of insurance guidelines and payer requirements and systems, including HMO/PPO, Medicare, and Medicaid. This is a remote, full-time role scheduled Monday through Friday, 8 a.m. to 5 p.m. Mountain Standard Time. The reported compensation is $22–$24 per hour.

Requirements

• At least 2 years of experience in collections, billing reimbursement, payer relations, or medical accounts receivable.
• Experience with commercial medical insurance billing, Medicaid, claims submission, and the technical aspects of billing software.
• Experience using all-in-one practice management, clearinghouse, and billing software.
• Proficiency navigating payer portals.
• Proficiency with CPT, HCPCS, and ICD-10 codes; DSMS and ASAM criteria; third-party billing and payer data entry; and payer reimbursement and denial patterns.
• Ability to work in a team, triage priorities, delegate tasks when needed, and handle conflict reasonably.
• Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections issues.
• Knowledge of HMO/PPO, Medicare, Medicaid, and other payer guidelines, requirements, and systems.
• Strong organizational skills and ability to multitask.
• Familiarity with major payer guidelines.
• Ability to manage multiple priorities concurrently.
• Meticulous attention to detail and a high level of accuracy.
• Ability to develop internal and external working relationships.
• Ability to work independently on several projects concurrently.

Nice To Haves

• Experience in a healthcare or behavioral health system with multiple levels of care.
• KIPU or similar EHR/EMR experience.
• Ethics, integrity, and confidentiality in handling employee and business issues.
• Ability to work independently and in a dynamic team environment.
• Commitment to maintaining professional and technical knowledge.
• Critical-thinking skills and organizational abilities.
• Clear, concise verbal and written communication skills.
• Ability to identify and resolve problematic situations quickly and effectively.
• Comfort analyzing information and dealing with complexity.
• Reliable handling of confidential material.
• Ability to communicate with individuals at all organizational levels.
• Ability to perform several tasks concurrently with professionalism.
• Ability to prioritize workload in a fast-paced environment.
• Proficiency with Microsoft Office Suite.

Responsibilities

• Perform collections to ensure receipt of medical claims within 28 days.
• Call insurance companies and use payer portals to resolve claims.
• Coordinate with insurers to support timely payment for services rendered.
• Follow billing and collection protocols to ensure accurate and timely reimbursement.
• Review accounts receivable for accurate reimbursement and payer issues that may delay payment.
• Contact payers to clarify denials and identify changes needed to receive payment.
• Prepare appeals when claim denials result from payer errors.
• Document all payer correspondence in the billing system.
• Coordinate with Utilization Review regarding prior authorization and medical necessity documentation.
• Maintain knowledge of CMS and third-party payer regulations and guidelines, and understand explanations of benefits.
• Maintain accurate patient billing and payment records.
• Provide management with reports on outstanding balances and collection activity.
• Communicate effectively and provide customer service.
• Apply knowledge of insurance billing and coding requirements.
• Maintain current working knowledge of Northpoint billing and reimbursement requirements by payer.
• Collaborate with the Revenue Cycle Management team and other departments to complete assigned duties and priorities.
• Maintain confidentiality in accordance with company policies, procedures, and standards of care.
• Adhere to company policies and procedures and perform other job-related duties as assigned.

Benefits

• Subsidized health insurance coverage for the employee, spouse, and dependents.
• Employer-paid basic life insurance equal to 1x annual salary, up to $100,000.
• Employer-paid Employee Assistance Program.
• Voluntary dental, vision, short-term disability, supplemental life and AD&D, critical illness, accident, and hospital indemnity insurance.
• Pre-tax savings accounts for IRS-allowable medical and dependent care expenses.
• Paid time off plan.
• Employee referral bonuses.
• 401(k) retirement plan with employer match.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed