Job DescriptionThe Billing Resubmissions & Denials Specialist is responsible for managing, analyzing, and resolving insurance claim denials and underpayments to ensure timely and accurate reimbursement. This remote role plays a critical part in the clinic’s revenue cycle by identifying denial trends, correcting claims, submitting appeals, and working closely with billing, coding, and clinical teams to minimize future denials.Key ResponsibilitiesDenials & AppealsReview and analyze denied, rejected, or underpaid insurance claims.Identify root causes of denials (coding errors, authorization issues, eligibility, medical necessity, timely filing, etc.).Prepare, submit, and track corrected claims and formal appeals.Follow up with payers to ensure proper adjudication and payment.Resubmissions & Follow-UpCorrect claim errors and resubmit claims within payer timelines.Monitor aging accounts and prioritize high-dollar or time-sensitive claims.Document all actions and communications clearly in billing systems.Collaboration & ReportingWork closely with coders, billers, front desk, and clinical staff to resolve recurring issues.Identify denial trends and recommend process improvements.Assist with audits and payer correspondence as neededComplianceEnsure compliance with HIPAA, payer guidelines, and clinic policies.Maintain confidentiality of patient and financial information.Required QualificationsHigh school diploma or equivalent (Associate’s degree preferred).2+ years of medical billing experience, with a strong focus on denials and resubmissions.Proven experience working with commercial payers, Medicare, and Medicaid.Strong knowledge of CPT, ICD-10, and HCPCS codes.Familiarity with EHR and billing systems.Excellent attention to detail and strong written communication skills.Preferred QualificationsExperience in neurology or specialty medical billing.Certification such as CPB, CPC, or CCS.Experience working remotely in a revenue cycle role.Skills & CompetenciesStrong analytical and problem-solving skills.Ability to manage multiple payers and deadlines independently.Organized, detail-oriented, and results-driven.Clear and professional communication with internal teams and payers.Base CompensationStarting at 26,000 MXN Pesos Monthly
