Claims Resolution Specialist

Orthopedic Care Partners

. Submit and track insurance and patient claims for government and commercial payers .

Posted 9/15/2026full-timeRemote • Florida • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical billing, claims follow-up, and revenue cycle management, with a strong understanding of payer guidelines and coding practices. Proficient in utilizing Electronic Health Record systems and Microsoft Office Suite to enhance operational efficiency and compliance.

Highest-signal resume keywords

Medical Billing ExperienceClaims Follow-UpRevenue Cycle ManagementCPT/ICD-10 CodingEHR Systems Proficiency

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical BillingClaims ProcessingCPT CodingICD-10 CodingDenial ManagementData EntryDocumentation SkillsClaim AdjudicationPayment PostingProcess Improvement

Soft Skills

Independent WorkDeadline ManagementAdaptabilityCommunication Skills

Tools & Technologies

Electronic Health Record (EHR)Practice Management SystemsMicrosoft Office SuiteExcelOutlook

Industry Keywords

Payer GuidelinesHIPAA ComplianceRevenue Cycle PerformanceOrthopedicsInsurance Billing Practices

About the role

Key responsibilities & impact

Submit and track insurance and patient claims for government and commercial payers
Perform timely follow-up on unpaid or denied claims to ensure proper reimbursement
Conduct root cause analysis on recurring denials or payment issues and escalate trends to management
Research payer policies and claim-specific requirements
Process write-offs and adjustments according to established protocols and payer contracts
Maintain clear, accurate documentation of claim-related activities and communications
Collaborate with clinical, billing, and coding staff to resolve claim issues
Monitor aging reports and prioritize follow-up based on payer deadlines and financial impact
Prepare reports and summaries of problem accounts, denial patterns, and process inefficiencies
Assist in implementing process improvements to reduce denials and enhance revenue cycle performance
Ensure compliance with HIPAA, payer guidelines, and internal billing policies
Perform other duties as assigned

Requirements

What you’ll need

High school diploma or equivalent required; associate's or bachelor's degree in healthcare administration, business, or related field preferred
2+ years of experience in medical billing, claims follow-up, or revenue cycle management required, preferably in Orthopedics
Working knowledge of government and commercial payer guidelines, medical terminology, CPT/ICD-10 coding, and insurance billing practices
Experience with Electronic Health Record (EHR) and Practice Management systems (e.g., ModMed, Epic, Athena, etc.)
Ability to work independently, meet deadlines, and adapt in a fast-paced environment
Experience communicating with patients regarding billing questions and payment options is a plus
Strong data entry and documentation skills
Proficiency with Microsoft Office Suite, particularly Excel and Outlook
Understanding of claim adjudication, payment posting, and denial management processes
Ability to fulfill office activities, including remaining seated for computer-based work, filing, and lifting/carrying office supplies
Occasionally lift and/or move up to 20–25 pounds
Travel may be required to existing or new OCP locations

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Orthopedic Care Partners Website LinkedIn All Job Openings 201 - 500 employees 🏥 Healthcare ⚕️ Healthcare Insurance 💊 Pharmaceuticals Healthcare
Healthcare Insurance
Pharmaceuticals Orthopedic Care Partners (OCP) is a leading and expansive network of orthopedic care providers, offering a comprehensive growth platform for orthopedic practices across the United States. OCP is known for its superior clinical reputation, scaled infrastructure, and outstanding patient experience. Through strategic partnerships and affiliations, OCP has become one of the largest orthopedic platforms, supported by over 138 physician partners and 42 clinics. They focus on maintaining clinical autonomy for practices, while leveraging shared resources to optimize value-based care. OCP is actively involved in Medicare’s BPCI Program and commercial bundled contracts, capitalizing on data analytics to enhance patient outcomes and reduce costs. Their commitment is to superior clinical outcomes and a great patient experience, while providing a vertically integrated clinical offering and strong physician alignment. The company is well positioned to thrive within the healthcare industry's shifts towards value-based care models. Claims Resolution Specialist Job not on LinkedIn 🔥 51 minutes ago 🐊 Florida – Remote ⏰ Full Time 🟢 Junior 🟡 Mid-level 🚫👨‍🎓 No degree required 👻 Ghost score 10% Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Submit and track insurance and patient claims for government and commercial payers
Perform timely follow-up on unpaid or denied claims to ensure proper reimbursement
Conduct root cause analysis on recurring denials or payment issues and escalate trends to management
Research payer policies and claim-specific requirements
Process write-offs and adjustments according to established protocols and payer contracts
Maintain clear, accurate documentation of claim-related activities and communications
Collaborate with clinical, billing, and coding staff to resolve claim issues
Monitor aging reports and prioritize follow-up based on payer deadlines and financial impact
Prepare reports and summaries of problem accounts, denial patterns, and process inefficiencies
Assist in implementing process improvements to reduce denials and enhance revenue cycle performance
Ensure compliance with HIPAA, payer guidelines, and internal billing policies
Perform other duties as assigned 🎯 Requirements
High school diploma or equivalent required; associate's or bachelor's degree in healthcare administration, business, or related field preferred
2+ years of experience in medical billing, claims follow-up, or revenue cycle management required, preferably in Orthopedics
Working knowledge of government and commercial payer guidelines, medical terminology, CPT/ICD-10 coding, and insurance billing practices
Experience with Electronic Health Record (EHR) and Practice Management systems (e.g., ModMed, Epic, Athena, etc.)
Ability to work independently, meet deadlines, and adapt in a fast-paced environment
Experience communicating with patients regarding billing questions and payment options is a plus
Strong data entry and documentation skills
Proficiency with Microsoft Office Suite, particularly Excel and Outlook
Understanding of claim adjudication, payment posting, and denial management processes
Ability to fulfill office activities, including remaining seated for computer-based work, filing, and lifting/carrying office supplies
Occasionally lift and/or move up to 20–25 pounds
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