Healthcare Billing Recovery Case Specialist I

What You’ll Do

• Review account claims and documentation to verify payment liability for claims potentially paid by Medicare in error.
• Leverage expertise in medical billing, COB, and MSP to review documentation, build case files, validate liability, evaluate defenses, status accounts, initiate correspondence, and resolve issues to achieve successful payment or appropriate account action.
• Initiate actions with insurance carriers, legal representatives, or other parties based on payment options, new information, or escalations for refusal to pay.
• Update client and company systems with accurate contact information, notes, payment commitments, and account status.
• Initiate claim activities, follow up to ensure timely and accurate documentation per policies.
• Support internal teams with EOB interpretation and development of healthcare billing knowledge base.
• Comply with company policies, HIPAA, federal/state regulations, training requirements, and performance metrics.
• Obtain and maintain required clearances, background checks, and drug screenings.
• Demonstrate core values, correct deficiencies from reviews, and work overtime or holidays as needed.

What You Bring

• Minimum 6 months of medical billing experience, including Medicare.
• Minimum 2 years of experience in customer service, billing reclamation/recovery, or call center roles.
• High School diploma or GED required.
• Knowledge of medical claim billing procedures, terminology, coding; familiarity with UB04 and CMS 1500 forms.
• Experience with Coordination of Benefits, Third Party Liability, Medicare Secondary Payer (MSP).
• Proven ability to interpret Explanation of Benefits (EOB) to resolve billing issues.
• Experience handling Medicare and Medicaid claims.
• Understanding of HIPAA standards and patient privacy.
• Strong interpersonal, communication, and customer service skills.
• Self-motivated, detail-oriented, able to multitask in fast-paced environment.
• Proficiency with office technology, computers, applications, and online tools.
• Ability to apply training, follow processes, work independently and in teams, adapt to changes.
• Ability to obtain/maintain clearances and pass screenings.
• Commitment to Teleworker Agreement (high-speed internet, suitable workspace for HIPAA compliance, dedicated focus).
• Ethical, friendly, hard-working, proactive personality.

What We Offer

• Work from anywhere in the US.
• Top Medical/Dental/Vision offerings, FSA/HSA, tuition reimbursement.
• Competitive salary, 401(k) with company match.
• Additional health and wellness benefits and perks.
• Flexible and trusting environment.

Pay range: $19.00 - $20.00 (hourly)