Denials & AR Recovery Specialist

Mochi Health•San Francisco, CA

3d•Onsite

About The Position

Mochi Health is hiring a Denials & AR Recovery Specialist for its growing insurance team. This hands-on, metrics-driven role owns recovery of insurance revenue from claims that are denied, rejected, underpaid, or delayed by payers. The specialist works claims through to resolution, files appeals within payer deadlines, follows up on aging accounts receivable, and shares denial patterns with the coding and billing team to help prevent repeat issues. The position has a direct impact on cash collected and first-pass claim performance. The specialist works closely with the coding and billing team and reports systemic payer issues to the RCM Lead. Success is measured by recovered denial dollars, appeal overturn rate, reduced days in AR and aged AR backlog, lower first-pass denial rates, and consistently meeting filing and appeal deadlines. The role is in person at Mochi Health’s San Francisco office, five days per week. Strong performers may have opportunities to specialize or move into a senior or lead denials position.

Requirements

At least 2 years of medical billing, claims, denials, or AR follow-up experience, ideally including commercial payer appeals.
Working knowledge of the full revenue cycle and CPT, ICD-10, and HCPCS coding concepts, with the ability to read and reason about claims.
Ability to interpret remittances and CARC/RARC denial codes and determine the correct next step, such as appeal, correction and resubmission, write-off, or escalation.
Familiarity with payer portals, clearinghouses, and billing or practice-management systems.
Comfort using spreadsheets to track, prioritize, and report on claim work.
Strong written communication skills for appeal letters, and persistence and attention to detail under deadline pressure.
High school diploma or equivalent.

Nice To Haves

Experience in telehealth, primary care, or a high-volume E&M billing environment.
A billing or revenue-cycle credential such as CPB (AAPC) or CRCR (HFMA); a CPC coding credential is a plus for coding-related denials.
An associate or bachelor’s degree in healthcare administration, business, or a related field.
Experience identifying denial trends and driving upstream process improvements, rather than only reworking claims.

Responsibilities

Work daily queues of denied, rejected, and underpaid claims, prioritizing by dollar value and timely-filing and appeal deadlines.
Review ERAs and EOBs and interpret CARC and RARC denial codes to identify the true cause of each denial and determine the appropriate next step.
Prepare and submit payer-compliant appeals supported by clinical documentation, medical-necessity rationale, and payer policy or contract language.
Correct and resubmit claims involving billing, coding, demographic, or eligibility errors, routing coding questions to the coding team.
Track claims through to resolution.
Monitor and work aging accounts receivable, following up with payers through portals, phone, and written correspondence.
Identify and pursue underpayments against expected allowed amounts and contracted rates.
Escalate systemic payer issues, including recurring denials, payer processing errors, and contract disputes, to the RCM Lead with supporting data.
Categorize denials by reason, payer, provider, and CPT code, and report recurring drivers each month.
Partner with the coding and billing team to address denial causes upstream and improve the first-pass clean-claim rate.
Flag coding or documentation patterns that could create compliance or audit exposure, including E&M level and modifier issues.
Document claim activity, notes, and outcomes accurately and in real time in the billing system.
Report on denial rate, denial dollars recovered, appeal success rate, and days in AR, and contribute to weekly team reviews.
Maintain patient and health information in accordance with HIPAA and company privacy and security policies.