Claims Resolution Specialist

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    "city": "Oak Brook",
    "region": "IL",
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    "datePosted": "2026-03-30",
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      "city": "Oak Brook",
      "state": "Illinois",
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    "description": "<p><span style=\"font-size: 12pt\">The Claims Resolution Specialist is responsible for managing Accounts Receivable and resolving clearinghouse rejections across multiple specialties and clients. This role requires deep end to end revenue cycle knowledge, with a primary focus on claim correction, payer follow up, and driving timely reimbursement.</span><br><br></p>\n<p><span style=\"font-size: 12pt\">This individual operates in a high volume, multi client environment and is expected to work independently, identify root causes, and reduce rework through accurate and efficient resolution of claim issues.<br><br></span></p>\n<p><span style=\"font-size: 12pt; font-weight: bold\">Core Responsibilities</span></p>\n<ul>\n<li><span style=\"font-size: 12pt\">Accounts Receivable Management</span></li>\n<li><span style=\"font-size: 12pt\">Perform timely follow up on outstanding AR across all aging buckets</span></li>\n<li><span style=\"font-size: 12pt\">Analyze unpaid claims, identify root causes, and take appropriate action to drive resolution</span></li>\n<li><span style=\"font-size: 12pt\">Work denials, rejections, and underpayments including corrections, resubmissions, and escalations</span></li>\n<li><span style=\"font-size: 12pt\">Ensure proper documentation of all actions taken within the practice management system</span></li>\n<li><span style=\"font-size: 12pt\">Prioritize accounts based on aging, dollar value, and payer specific trends</span></li>\n<li><span style=\"font-size: 12pt\">Clearinghouse Rejection Resolution</span></li>\n<li><span style=\"font-size: 12pt\">Review and correct clearinghouse rejections daily to ensure clean claim submission</span></li>\n<li><span style=\"font-size: 12pt\">Identify trends in rejection types and implement corrective actions to reduce recurrence</span></li>\n<li><span style=\"font-size: 12pt\">Validate claim data including demographics, coding, modifiers, and payer requirements</span></li>\n<li><span style=\"font-size: 12pt\">Resubmit corrected claims within defined turnaround times</span></li>\n</ul>\n<p><span style=\"font-size: 12pt; font-weight: bold\">Claims &amp; Billing Accuracy</span></p>\n<ul>\n<li><span style=\"font-size: 12pt\">Ensure claims are billed in accordance with payer guidelines and client specific rules</span></li>\n<li><span style=\"font-size: 12pt\">Validate coding, modifiers, and required data elements prior to submission</span></li>\n<li><span style=\"font-size: 12pt\">Collaborate with front end and coding teams to resolve upstream issues impacting claim quality</span></li>\n</ul>\n<p><span style=\"font-size: 12pt; font-weight: bold\">Root Cause Analysis &amp; Process Improvement</span></p>\n<ul>\n<li><span style=\"font-size: 12pt\">Identify patterns in denials and rejections and escalate systemic issues</span></li>\n<li><span style=\"font-size: 12pt\">Provide feedback to leadership on workflow gaps, payer trends, and process breakdowns</span></li>\n<li><span style=\"font-size: 12pt\">Support initiatives focused on reducing AR days, denial rates, and rework</span></li>\n<li><span style=\"font-size: 12pt\">Cross Functional Collaboration</span></li>\n<li><span style=\"font-size: 12pt\">Partner with internal teams including QA, Automation, and Client Success to resolve issues</span></li>\n<li><span style=\"font-size: 12pt\">Communicate effectively with clients when required to clarify billing or payer requirements</span></li>\n<li><span style=\"font-size: 12pt\">Adapt to multiple EMRs, clearinghouses, and payer systems across clients</span></li>\n</ul>\n<p><span style=\"font-size: 12pt; font-weight: bold\"><br>Required Qualifications</span></p>\n<ul>\n<li><span style=\"font-size: 12pt\">Minimum 5 plus years of experience in Revenue Cycle Management with strong focus on AR follow up and claims or rejections</span></li>\n<li><span style=\"font-size: 12pt\">Proven experience working clearinghouse rejections and payer denials across multiple specialties</span></li>\n<li><span style=\"font-size: 12pt\">Strong understanding of the full revenue cycle including billing, coding fundamentals, and payer guidelines</span></li>\n<li><span style=\"font-size: 12pt\">Experience working with multiple EMRs and clearinghouses such as Availity, Change Healthcare, Waystar or similar</span></li>\n<li><span style=\"font-size: 12pt\">Ability to manage high volume workloads while maintaining accuracy and productivity standards</span></li>\n<li><span style=\"font-size: 12pt\">Strong analytical and problem-solving skills</span></li>\n</ul>\n<p><span style=\"font-size: 12pt\">Preferred Qualifications</span></p>\n<ul>\n<li><span style=\"font-size: 12pt\">Multi-specialty experience including radiology, ophthalmology, or surgical practices</span></li>\n<li><span style=\"font-size: 12pt\">Experience in a multi-client or outsourced RCM environment</span></li>\n<li><span style=\"font-size: 12pt\">Familiarity with automation tools or workflow optimization initiatives</span></li>\n</ul>\n<p><span style=\"font-size: 12pt\">Key Performance Indicators</span></p>\n<ul>\n<li><span style=\"font-size: 12pt\">AR resolution rate and reduction in aging</span></li>\n<li><span style=\"font-size: 12pt\">Clearinghouse rejection turnaround time</span></li>\n<li><span style=\"font-size: 12pt\">Denial resolution rate and rework reduction</span></li>\n<li><span style=\"font-size: 12pt\">Productivity and quality accuracy scores</span></li>\n<li><span style=\"font-size: 12pt\">Contribution to overall cash acceleration and revenue recovery</span></li>\n</ul>\n<p><span style=\"font-size: 12pt\">Work Environment</span></p>\n<ul>\n<li><span style=\"font-size: 12pt\">Fast-paced, metrics driven environment supporting multiple clients</span></li>\n<li><span style=\"font-size: 12pt\">Requires adaptability across systems, workflows, and payer requirements</span></li>\n<li><span style=\"font-size: 12pt\">Strong emphasis on accountability, accuracy, and continuous improvement</span></li>\n</ul>",
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