Billing & Insurance Claims Specialist (Healthcare)
About the RoleWe’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 resolutionWhat 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 autonomouslyNice to Have• Experience supporting small or growing healthcare practices• Familiarity with ACA and employer-sponsored plans• Experience coordinating with attorneys, compliance teams, or external reviewersWhyThis 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