Under the direction of the Supervisor and Team Lead/Manager, this role is responsible for insurance follow-up on carrier denials, no-insurance responses, and claim edits for Yale Medicine.
The position serves as a liaison for day-to-day follow-up on denied and no-response claims to help obtain maximum reimbursement for services rendered by Yale Medicine and related practices. Responsibilities include reviewing payment history, resolving delinquent accounts, composing correspondence, researching individual accounts, and documenting follow-up actions on claims worked through payment, rejection, or edits.
The role also supports review and validation of charge review and claim edits to ensure correct coding, billing guidelines, and compliance with Yale Medicine policies. It requires close communication with insurance carriers, patients, and internal departments to investigate reimbursement delays and resolve billing issues.
Required
- 4 years of related work experience, including 2 years in the same job family at the next lower level; or 2 years of related work experience and an associate degree; or an equivalent combination of education and experience
- Knowledge of healthcare revenue cycle operations, including insurance billing, claims processing, eligibility, reimbursement, and denial management
- Working knowledge of CPT, ICD-10, HCPCS, modifiers, NCCI edits, and MUEs
- Ability to research, analyze, resolve, and/or escalate insurance denials, claim rejections, timely filing issues, and coverage discrepancies
- Proficiency with billing systems, workqueues, patient accounts, payer information, and revenue cycle workflows
- Strong analytical, problem-solving, written, and verbal communication skills
- Ability to manage multiple priorities, meet productivity expectations, and work independently
Preferred
- Experience with complex denials, appeals, payer disputes, and denial trend analysis
- Experience with Waystar or other clearinghouse and payer portal systems
- Process improvement experience focused on reducing recurring denials and improving clean claim performance
- CPC, CPB, or related billing/coding/revenue cycle certification or coursework
- Experience using Microsoft Excel or reporting tools for claim monitoring and trend analysis
Location
Connecticut, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago