Medical and Dental Claims Denial Resolution Specialist; England

Medical and Dental Claims Denial Resolution Specialist (New England)

Join to apply for the Medical and Dental Claims Denial Resolution Specialist (New England) role at Health Drive Corporation

Health Drive is seeking a full‑time Medical and Dental Claims Denial Resolution Specialist to join our team! The Medical and Dental Claims Denial Resolution Specialist is responsible for daily review and resolution of insurance claim denials and/or unpaid/incorrectly paid claims with the primary goal to increase cash collections and minimize bad debt write‑offs.

This individual must have extensive experience working with claim denial resolution for all insurance plan types, including Medicare Part B, Medicare Advantage, Medicaid, Medicaid MCO, private insurance and BCBS. The hourly pay range for this position is $22.00 - $27.00 per hour.

We are conveniently located off Route 9 in Framingham, MA, close to routes 90 and 495 in a spacious modern office with a workout center available right in the building!

What's in it for you: PPO Medical, Dental, and Vision insurance; 401(k) + company match; paid time off; hybrid schedule opportunity;
Verizon Wireless, Dell, and other employee discounts; profit sharing; and employee referral bonuses.

Health Drive delivers on‑site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long‑term care, skilled nursing, and assisted living facilities. Each specialty offered by Health Drive directly impacts the quality of daily life for our residents. Health Drive connects patients in need of vital healthcare to doctors committed to dignity and excellence.

• Identify, investigate, and follow up with insurance plans daily to expedite resolution of denied, incorrectly paid, or unpaid claims.
• Submit corrected claims and appeals online to obtain payment within the insurance plan’s timely filing and appeal limits.
• Obtain and verify new/corrected insurance information using clearinghouse or insurance websites prior to re‑billing claims to new/updated insurances.
• Document and communicate ongoing denial or incorrect payment issues for a specific insurance plan that require assistance from manager and/or director to help resolve.
• Become the expert on the billing and claim requirements for assigned insurance plans.
• Utilize insurance plan website(s) to check eligibility, claim status, submit online appeals, or provide Explanation of Benefits (EOBs) / Explanation of Payments (EOPs) required for processing secondary/tertiary claims.
• Review and resolve over payments, submit requests for insurance to retract payment, and request refund through an automated process in the billing system.
• Identify and communicate payment posting issues to cash application team.
• Meet or exceed daily productivity objectives for all assigned duties.
• Respond to email inquiries or Teams chat messages regarding questions/issues with your assigned AR plans within 24 hours.
• Work professionally and cooperatively with facilities, responsible parties, insurance carriers, and all internal and external customers.
• Assist with development of training materials/cheat sheets for assigned insurance plans and actively participate in training of other employees as needed.
• Perform other duties and tasks assigned or necessary to meet business needs/objectives.

• Prefer minimum of 5 years of experience in a professional physician multispecialty group specifically managing medical and dental claims denial resolution.
• Extensive knowledge of third‑party billing practices and regulations for insurances in New England (Medicare Part B, Medicare Advantage, Medicare Supplemental, BCBS, private insurance, Medicaid, and Medicaid Managed Care plans).
• Knowledgeable of the claim adjustment (CARC) and remark reason codes (RARC) from Electronic Remittance Advices (ERA/835 files) and from paper Explanation of Benefits (EOBs)/Explanation of Payments (EOPs), CPT, and ICD‑10 codes.
• Highly organized, with excellent attention to detail and persistent follow‑up, problem‑solving, and analytical skills.
• Must have strong ability to self‑direct and work independently in a high‑volume, deadline‑driven role.
• Demonstrated proficiency in Microsoft Office applications (Excel, Outlook, Word, and Teams), medical billing software, insurance plan websites, and provider manuals.
• Excellent interpersonal and communication skills with professional demeanor and positive attitude who readily adapts to change and effectively and appropriately communicates both verbally and in writing.
• Collaborator with ability to establish priorities, effectively multitask to meet objectives and deadlines.
• Strong time management and organizational skills; demonstrated ability to independently prioritize.
• Knowledge of HIPAA regulations and patient privacy rules.

• Seniority level:
  Mid‑Senior level
• Employment type:
  
  Full‑time
• Job function:
  Health Care Provider
• Industry: Hospitals and Health Care