Medical Billing Specialist – Denial Management

🔥 31 minutes ago

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Alpaca Health

WebsiteLinkedInAll Job Openings

2 - 10 employees

Founded 2024

🏥 Healthcare

👥 B2C

Healthcare • B2C

Alpaca Health is a provider network that delivers personalized Applied Behavior Analysis (ABA) therapy for children with autism spectrum disorder and developmental delays. They connect families with local, independent clinicians (BCBAs and therapists) and offer flexible care models — in-home, in-clinic, in-school, in-daycare, in-community, and virtual sessions — designed to integrate into a family’s daily routine. Alpaca Health provides diagnostic support (including free online screening tools and ADOS-2 assessments for young children), accepts many major insurance plans and is in-network with 100+ payers across states such as Texas, Colorado, North Carolina, and Hawaii.

📋 Description

• Own rejections, denials, and denied claims workflows from identification through resolution • Monitor ERA activity daily and perform same-day touches on denials and rejections • Drive improvements in Net Collection Rate and payer turnaround times • Manage reprocessing timelines and ensure timely resubmission of corrected claims • Investigate root causes of denials and coordinate corrective actions across teams • Work denied, underpaid, and unpaid claims through payer portals, calls, and written appeals • Track trends in denials by payer, authorization, coding, documentation, or eligibility issues • Coordinate with billing, credentialing, clinical, and operations teams to resolve revenue barriers • Maintain accurate denial tracking, follow-up notes, and resolution documentation • Escalate high-risk or aging denials proactively • Assist with payer communication via phone, portal, fax, and email • Support process improvement initiatives to reduce future denials and revenue leakage

🎯 Requirements

• Bachelor’s degree or equivalent experience • Excellent attention to detail and organizational skills • Background in a call center or high-call-volume operational role • At least 3 years of experience in healthcare billing, collections, denials, or revenue cycle management • Experience working with US-based commercial and government health insurance payers • Strong understanding of denials, rejections, EOBs, ERAs, and claims reprocessing workflows • Strong communication and problem-solving abilities • Comfortable handling payer calls and navigating payer portals • Proficient in MS Office, billing systems, and operational tools • Ability to manage multiple priorities and meet deadlines in a fast-paced environment

🏖️ Benefits

• This role is remote. We’re looking for candidates based outside of the United States, but able to work United States East Coast time zones.