[Hiring] Medical Billing Resolution Specialist @Expressable

Role Description

The Medical Billing Resolution Specialist owns end-to-end claim resolution to ensure timely, accurate reimbursement and a clear, professional client billing experience. This role resolves denied, rejected, and held claims; supports medical necessity and authorization reviews; partners cross-functionally to prevent recurring issues; supports client invoicing during accounts receivable review; and engages directly with clients on escalated billing questions or concerns.

What You Would Be Doing at Expressable:

• Own the end-to-end resolution of rejected, denied, and held claims, including medical necessity, eligibility, authorization, and coding-related issues, through final payment or closure.
• Research, correct, refile, and appeal denied claims, ensuring appropriate clinical documentation and medical necessity support.
• Perform medical necessity reviews for continued services, partnering with clinical teams to validate documentation and payer criteria.
• Research payer medical policies, coverage determinations, and contract terms; communicate with insurance plans as needed.
• Maintain accountability for assigned claim inventories, including documentation, tracking, and system updates in billing platforms, EHR, and CRM tools.
• Identify denial trends and root causes and recommend process or documentation improvements to prevent future issues.
• Manage invoicing, accounts receivable, client payments, and balance reconciliation, including applicable discounts.
• Serve as a client-facing resource for billing and insurance inquiries, resolving issues related to benefits, claim status, invoices, and payments.
• Collaborate with internal teams and external revenue cycle partners to support coordinated claim research and appeals.
• Escalate complex or high-risk issues appropriately while ensuring compliance with HIPAA, payer, and company requirements.

Qualifications

• High school diploma or equivalent required.
• Associate degree or coursework in healthcare administration, medical billing, health information management, or a related field preferred.
• 2–4 years of experience in medical billing, revenue cycle, or claims resolution in a healthcare setting.
• Demonstrated experience resolving denied, rejected, or held claims, including eligibility, authorization, coding, and medical necessity denials.
• Experience reviewing payer medical policies and working directly with insurance plans on claim status, appeals, and reimbursement issues.
• Prior responsibility for accounts receivable follow-up, invoicing, and patient/client billing support.
• Experience collaborating with clinical or utilization management teams preferred.
• Working knowledge of medical billing and reimbursement processes, including claim submission, denial management, and appeals.
• Proficiency with ICD-10 coding validation and basic understanding of medical necessity requirements.
• Experience using electronic health records (EHR), billing systems, and CRM or ticketing tools.
• Strong documentation and data entry skills with attention to accuracy and audit readiness.
• Proficiency with Microsoft Excel and/or Google Sheets for tracking, reconciliation, and reporting.

Requirements

• Claims Resolution & Follow-Through: Takes ownership of issues through final resolution, manages competing priorities, and ensures timely outcomes.
• Medical Necessity & Payer Policy Acumen: Interprets payer policies, coverage criteria, and documentation requirements to support reimbursement and continued services.
• Analytical Problem Solving: Investigates denials, identifies root causes, and applies structured thinking to resolve complex billing issues.
• Attention to Detail & Compliance Orientation: Maintains high standards for accuracy, documentation, and adherence to HIPAA, payer, and internal requirements.
• Client & Payer Communication: Communicates clearly and professionally with clients, payers, and internal stakeholders to resolve issues and set expectations.
• Continuous Improvement Mindset: Identifies trends, recommends process improvements, and contributes to reducing future denials and rework.

Benefits

• Exceptional paid time off policies that encourage and support life balance, including a winter break.
• 401k matching to ensure our staff have what they need to enjoy their retirement.
• Health insurance options that ensure well being for the whole person and their family.
• Company paid life, short-term disability, and long-term disability coverage.
• Remote work environment that strives for connectivity through professional collaboration and personal connections.