If you’re the person who doesn’t stop at “denied” and knows how to fight for reimbursement with facts, policies, and airtight documentation, this role is for you. You’ll dig into complex payer denials, build strong appeals, and help keep revenue moving so patient care doesn’t get stuck in paperwork limbo.
About VitalConnect
VitalConnect supports healthcare operations through strong revenue cycle practices that protect reimbursement and keep the financial clearance process on track. This team partners closely with payers, patients, physicians, and practice staff to resolve issues quickly and compliantly.
Schedule
- Fully remote
- Location: Remote (CA)
- Revenue Cycle role with productivity and quality assurance standards
What You’ll Do
- Research and resolve complex third-party payer claim denials and outstanding claims
- Investigate denials related to referrals, authorizations, notifications, medical necessity, non-covered services, and billing issues
- Determine the correct action path: obtain authorization, submit written appeal, or take no action when appropriate
- Write and submit detailed, professionally written appeals using clinical documentation, payer medical policies, and contract language
- Customize appeals per Medicare, Medicaid, and third-party payer guidelines and internal policies
- Use payer portals, phone, and correspondence to follow up on reimbursement and appeal status
- Track, trend, and report recovery efforts, payer issues, and recurring denial drivers
- Ensure eligible accounts are appealed within payer timeframes and documented correctly in patient systems
- Meet productivity standards while identifying root causes and improving denial resolution outcomes
- Review daily payer correspondence to proactively reconcile denials
- Escalate exhausted accounts that cannot be financially cleared per department policy
- Maintain strict confidentiality and compliance with HIPAA and applicable state/federal regulations
- Support team A/R goals and assist with related duties as assigned
What You Need
- Bachelor’s degree or equivalent work experience
- 3+ years in medical collections with denials, appeals, insurance collections, and follow-up experience
- Strong knowledge of healthcare terminology and CPT/ICD-10 coding
- Strong understanding of insurance plans, coordination of benefits, EOBs, coverage/utilization guidelines, timely filing, and denial/remit codes
- Experience using payer portals (e.g., NaviNet, Availity) to retrieve info and upload appeals
- Strong analytical judgment, attention to detail, and comfort working in ambiguity
- Strong written communication skills (appeal writing is a core skill)
- Ability to balance multiple priorities and handle challenging situations professionally
- Basic computer proficiency, including Microsoft Excel and Word
- Strong understanding of revenue cycle processes and ability to meet productivity standards
- Commitment to confidentiality and compliance (HIPAA)
Benefits
- Pay range: $22–$24/hour (based on geography, skills, education, and experience)
- Medical insurance
- Dental insurance
- 401(k) retirement plan
If you’ve got denial and appeals experience and you like solving puzzles with real financial impact, this is a solid remote opportunity worth applying to now.
Happy Hunting,
~Two Chicks…