Billing & Insurance Claims Specialist (Healthcare)
About the Role We’re seeking an experienced Billing & Insurance Claims Specialist to take ownership of end-to-end healthcare claims operations for a growing practice. This role is ideal for someone who thrives in complex payer environments, understands payer portals and escalation paths, and has a demonstrated history of recovering significant revenue through disciplined follow-up, appeals, and dispute resolution. This is not a data-entry role. We’re looking for a specialist who knows how to navigate payer behavior, portals, and processes to efficiently recover claims for small businesses. What You’ll Do • Manage the full claims lifecycle: submission, follow-up, denial management, appeals, and payment posting • Operate confidently in Tebra, Availity, and comparable practice management and payer portal systems • Identify, investigate, and resolve denied, delayed, or underpaid claims across multiple payers • Prepare and submit first-level and advanced appeals, including administrative and clinical narratives • Escalate claims to payer leadership, legal counsel, or independent review organizations (IRP / IRO) when appropriate • Track claim aging, identify systemic payer or workflow issues, and recommend improvements to increase collections velocity • Maintain clean, defensible documentation to support audits, appeals, and dispute resolution What We’re Looking For • 5+ years of healthcare billing and insurance claims experience • Proven track record of: • Recovering $100K+ in unpaid or denied claims, or • Successfully processing $1M+ in cumulative claims volume • Strong working knowledge of: • Tebra (required) • Availity and other payer portals • Claims workflows, EOBs/ERAs, denial reason codes, and payer-specific policies • Hands-on experience with: • Appeals and dispute resolution • Independent Review Process (IRP / IRO) • Legal or pre-legal escalation pathways • Highly organized, persistent, and comfortable working autonomously Nice to Have • Experience supporting small or growing healthcare practices • Familiarity with ACA and employer-sponsored plans • Experience coordinating with attorneys, compliance teams, or external reviewers Why This Role • High-impact work with measurable financial outcomes • Autonomy and trust—results matter more than hours • Opportunity to stabilize and scale claims operations long-term Apply tot his job