Denials & AR Recovery Specialist

Mochi Health•San Francisco, CA

1d•$80,000 - $100,000•Onsite

About The Position

Mochi Health is hiring a Denials & AR Recovery Specialist to own recovery of insurance revenue from claims that are denied, rejected, underpaid, or delayed by payers. This hands-on, metrics-driven role works across the back end of the revenue cycle and has a direct impact on cash collected. The specialist will resolve claims, submit timely appeals, follow up on aging accounts receivable, and identify denial patterns so preventable issues can be addressed upstream with the coding and billing team. The role is based in Mochi Health’s San Francisco office and is in person five days a week. The specialist will work alongside the coding and billing team. Strong performers may have opportunities to specialize further or move into a senior or lead denials position as the insurance team grows.

Requirements

At least 2 years of medical billing, claims, denials, or accounts-receivable follow-up experience; commercial payer appeals experience is ideal.
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 read remittances and act on CARC/RARC denial codes, determining whether to appeal, correct and resubmit, write off, or escalate.
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, plus 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); CPC coding credential is a plus for coding-related denials.
Associate or bachelor's degree in healthcare administration, business, or a related field.
Experience identifying denial trends and driving upstream process fixes, rather than only reworking claims.

Responsibilities

Work daily queues of denied, rejected, and underpaid claims, prioritizing by dollar value and filing or appeal deadlines.
Review ERAs and EOBs and interpret CARC and RARC denial codes to identify denial causes and appropriate next steps.
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, and route coding questions to the coding team.
Track claims through resolution rather than resubmitting without follow-up.
Monitor aging accounts receivable and follow up with payers by portal, phone, and written correspondence until accounts are resolved.
Identify and pursue underpayments against expected allowed amounts and contracted rates.
Escalate recurring denials, payer processing errors, contract disputes, and other systemic payer issues to the RCM Lead with supporting data.
Categorize denials by reason, payer, provider, and CPT code, and report recurring drivers monthly.
Partner with coding and billing teams 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 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.