Job Summary
We're looking for an experienced A/R professional who excels at resolving denied, underpaid, and aged claims not just tracking them. This person will own a portfolio of accounts, dig into root causes of non-payment, and drive claims to resolution through appeals, corrections, and direct payer negotiation. Ideal for someone who treats every denial as a puzzle to solve, not a box to check.
Key Responsibilities
- Take ownership of a claims/account and drive resolution to $0 balance — not just documented follow-up
- Resolve a high daily volume of denials, balancing speed with accuracy and long-term recovery rate
- Analyze denial codes and EOBs/ERAs to identify root cause (coding error, eligibility issue, timely filing, medical necessity, bundling, etc.)
- Draft and submit appeals with supporting documentation for denied or underpaid claims
- Negotiate directly with insurance payers/adjusters to resolve payment disputes
- Correct and resubmit claims (coding corrections, COB updates, missing info) with a high first-pass resolution rate
- Identify denial trends and root causes, and recommend upstream process fixes to prevent recurrence
- Prioritize high-dollar and high-risk aged accounts to minimize write-offs
- Escalate only what truly needs escalation — resolve the rest independently
- Track and report daily on volume resolved, resolution rate, and recovered dollars
- Stay current on payer policy changes, timely filing limits, and appeals processes
Required Qualifications
- 3+ years of hands-on experience resolving (not just following up on) insurance claims
- Proven track record of successfully appealing and overturning denials
- Strong working knowledge of denial codes (CARC/RARC), EOBs/ERAs, and payer adjudication
- Experience with claims scrubbers, clearinghouses, and payer portals
- Ability to read a denial and know the fix — not just log it and wait
- Excellent written communication for appeals and payer correspondence
- Ability to work efficiently at high volume without sacrificing accuracy or overturn rate
Preferred Qualifications
- Experience across multiple payer types (Medicare, Medicaid, commercial, workers' comp)
- Background in high-volume or complex specialty billing
- Analytical, root-cause problem-solving
- Persistence and follow-through on multi-step appeals
- High attention to detail under volume pressure
- Self-directed — flags patterns instead of just processing claims
Compensation & Work Location
Pay: 70-80K (depending on experience level)
Location: Onsite — office-based position (Ormoc , Leyte), no remote/work-from-home option
Skills Required
- 3+ years of hands-on experience resolving insurance claims
- Proven track record of successfully appealing and overturning denials
- Strong working knowledge of denial codes (CARC/RARC), EOBs/ERAs, and payer adjudication
- Experience with claims scrubbers, clearinghouses, and payer portals
- Ability to diagnose denials and determine fixes rather than only logging issues
- Excellent written communication for appeals and payer correspondence
- Ability to work efficiently at high volume without sacrificing accuracy or overturn rate
- Experience across multiple payer types (Medicare, Medicaid, commercial, workers' comp)
- Background in high-volume or complex specialty billing
- Analytical, root-cause problem-solving skills
- Persistence and follow-through on multi-step appeals
- High attention to detail under volume pressure
- Self-directed, able to identify and flag denial patterns
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What We Do
We are on a mission to improve health outcomes for more than 60 million Medicare-eligible Americans. Healthcare is confusing, fragmented, and expensive. Too many people don't understand what their plans actually cover. It’s too hard to make smart care choices. Chronic conditions go unnoticed. EasyHealth saw an opportunity to build stronger connections between coverage and care. For the first time, we created a complete end to end health experience, Our powerful network of healthcare providers, insurance agents, and ai is creating better health outcomes, starting with the 60 million Medicare members. For members, we create better health outcomes by connecting coverage and care. For plans, we are improve member engagement and health risk management. All of this is powered by Ayla, our smart health assistant built on disruptive ai. Interested in creating better health outcomes with technology? Have an idea for how to create meaningfully better member experiences with data, ai and design? Come join us - https://www.joineasyhealth.com/careers
