Reqroute, Inc · 1 day ago
Epic Claims Specialist
United States
Contract
Remote
Entry Level
$23/hr - $23/hr
1+ years expReqroute, Inc is seeking an Epic Claims Specialist to manage and optimize the lifecycle of hospital and professional claims across third-party payers. The role involves ensuring timely and accurate reimbursement for healthcare services while maintaining compliance with US payer regulations.
Staffing & Recruiting
Responsibilities
Manage accounts receivable processes for hospital and professional claims, ensuring compliance with US payer regulations
Analyze and resolve outstanding claims, including denials and underpayments, using payer-specific portals and resources
Investigate root causes of denials, apply appropriate ICD-10 and CPT codes, and implement corrective actions to maximize reimbursement
Prepare and submit appeals to insurance companies and Medicare, including redetermination requests and supporting documentation
Perform online submission of claims and monitor claim status through portals
Review aged receivables, recommend write-offs for uncollectible accounts, and report findings to the Account Manager
Maintain up-to-date knowledge of payer policies, federal and state regulations (HIPAA, CMS guidelines), and industry best practices
Collaborate with internal teams and external payers to resolve complex claim issues and expedite payment
Qualification
Required
Bachelor's degree or equivalent experience required; preferred in Business, Healthcare Administration, or related field
Minimum 1–2 years of hands-on experience in US healthcare revenue cycle management, with a focus on hospital and professional claims
In-depth understanding of UB-04 and CMS-1500 claim forms, ICD-10, CPT/HCPCS coding, and payer guidelines
Exceptional communication and interpersonal skills; able to interact professionally with payers, providers, and team members
Strong problem-solving and critical thinking abilities, with attention to detail and accuracy
Demonstrated ability to prioritize tasks, manage multiple deadlines, and adapt to changing regulatory requirements
High level of integrity, work ethic, and commitment to organizational goals
Proficiency in healthcare billing software, payer portals, and Microsoft Office Suite
Preferred
Experience with US hospital billing systems (Epic, Cerner, Meditech, etc.)
Familiarity with payer regulations, including appeals and redetermination processes
Ability to work independently and as part of a collaborative team
Company
Reqroute, Inc
Reqroute is a Staffing and Recruitment Marketing firm based in the heart of Silicon Valley in California.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Terrina Butler
Vice President of Strategy and Client Partnerships
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