Medical Claims Resolution Specialist

Metro Vein Centers•Detroit, MI

7h•Remote

About The Position

Metro Vein Centers is seeking a detail-oriented Medical Claims Resolution Specialist to support our billing and revenue cycle operations. This role is responsible for resolving denied, underpaid, and aging insurance claims while helping ensure accurate reimbursement and timely account resolution. You’ll work directly with insurance payers, payer portals, billing systems, and internal operational teams to investigate claim issues, submit appeals, and reduce revenue delays across our growing national clinic network. The ideal candidate has prior experience in medical billing, insurance follow-up, denial resolution, or accounts receivable within a healthcare environment. Success in this role requires strong problem-solving skills, attention to detail, urgency, and the ability to manage high claim volumes while navigating complex payer guidelines. This is a fully remote role supporting Metro Vein Centers’ growing national operations. The ideal candidate is highly organized, detail-oriented, and comfortable working independently in a fast-paced, high-volume claims environment.

Requirements

Ability to work independently and maintain productivity in a fully remote environment
Strong understanding of medical billing, claims follow-up, denial management, and insurance workflows
Knowledge of CPT, ICD-10, EOBs, payer guidelines, and medical billing terminology
Comfortable navigating payer portals, EMR systems, and healthcare billing platforms
Strong analytical and problem-solving skills with attention to detail
Ability to manage multiple claims and deadlines within a fast-paced environment
Clear written and verbal communication skills when working with payers and internal teams
Organized, self-motivated, and accountable work style
High school diploma or equivalent required
2+ years of experience in medical billing, insurance follow-up, denial resolution, claims management, or healthcare revenue cycle operations required

Nice To Haves

Prior experience with surgical, specialty practice, outpatient, or procedural billing strongly preferred
Familiarity with Centricity / Athena EMR preferred
Experience reviewing appeals, denials, EOBs, and payer correspondence strongly preferred

Responsibilities

Investigating denied or underpaid medical claims
Following up with insurance payers through portals and phone communication
Reviewing payer guidelines and submitting claim appeals
Managing aging reports and prioritizing time-sensitive accounts
Reprocessing claims and updating billing information within the EMR system
Collaborating with billing, coding, and operational teams to resolve claim issues
Managing multiple claims simultaneously while maintaining productivity and accuracy standards
Investigate and resolve denied, unpaid, or underpaid insurance claims
Submit timely and accurate appeals based on payer-specific guidelines and supporting documentation
Follow up on aging claims through payer portals, phone calls, and billing systems
Review claim edits, rejections, and payment discrepancies to determine resolution steps
Perform insurance re-verification and reprocess claims as needed
Post adjustments, payments, and account updates accurately within the EMR system
Maintain detailed documentation regarding claim follow-up activity and payer communication
Collaborate with internal billing, coding, and operational teams to reduce recurring denials and reimbursement delays
Support departmental productivity, quality, and turnaround time expectations