Seasoned Customer Service & Denial Specialist – Remote Healthcare Billing & Claims Management Expert

About brighthush

brighthush is a forward‑thinking healthcare organization that places compassion, innovation, and patient‑centric care at the core of everything we do. Operating across a network of state‑of‑the‑art imaging centers, we empower our patients to receive accurate, timely diagnostics while ensuring the financial health of our practice. Our culture is built on collaboration, continuous learning, and a commitment to diversity and inclusion. As a remote‑first company, we offer the flexibility of working from home while still fostering a strong sense of community through virtual team events, mentorship programs, and regular knowledge‑sharing sessions.

Key Responsibilities

As a Customer Service & Denial Specialist at brighthush, you will play a pivotal role in maintaining the financial integrity of our billing operations and delivering exceptional patient support. Your day‑to‑day duties will be organized around four core focus areas:

1. Denial Management (≈ 40%)

• Review denied claims in the Denial Tickler within Imagine or those assigned by the Team Lead or Billing Manager.
• Determine the appropriate action: validate the denial, prepare an appeal, initiate a carrier inquiry, or correct coding/insurance details.
• Collaborate with certified coders for CPT/ICD‑10/modifier changes and ensure all corrections are approved before re‑filing.
• Track appeal deadlines, carrier‑specific requirements, and denial trends, reporting findings to Billing and Coding managers.
• Document all findings and decisions in a clear, concise manner for audit and compliance purposes.

2. Follow‑Up & Claims Investigation (≈ 25%)

• Investigate outstanding claims in the billing system’s outstanding tickler queue.
• Utilize carrier websites, phone contacts, and internal resources to determine claim status and resolve processing issues.
• Provide credit balance information to the refund department and post insurance responses with supporting documentation.
• Escalate complex issues to the Billing Manager and work cross‑functionally to close open items.

3. Customer Support & Patient Interaction (≈ 20%)

• Handle inbound telephone calls, emails, voicemails, and written correspondence from patients regarding account inquiries.
• Process credit card payments through the merchant processing system, ensuring PCI compliance.
• Provide accurate price quotes, good‑faith estimates for self‑pay or uninsured patients, and set up realistic payment plans.
• Collaborate with clinic staff to answer billing questions that arise during patient visits.
• Maintain a patient‑first mindset, turning every interaction into an opportunity to reinforce brighthush’s commitment to care.

4. EDI & Administrative Support (≈ 15%)

• Review electronic claim rejections, research rejection codes, and re‑bill services after necessary adjustments.
• Verify pre‑eligibility checks, confirm charge accuracy, and update records accordingly.
• Process return mail from patients and payers, taking appropriate action per protocol.
• Document, distribute, resolve, and scan miscellaneous correspondence into the document management system.
• Review CMS‑1500/UB‑04 claim forms for accuracy and completeness.

Essential Qualifications

• High school diploma or GED; fluency in reading, writing, and speaking English.
• Minimum of two (2) years of experience in medical billing, insurance claims, or a related field.
• Proficiency with Microsoft Office, email, and internet research tools.
• Strong organizational skills, the ability to multitask, and make quick yet accurate decisions.
• Excellent communication skills, both written and verbal, with the ability to interact effectively with internal teams and external customers.
• Physical ability to perform repetitive computer tasks, lift up to 25 pounds, and maintain visual and auditory focus in a typical office or home‑office setting.

Preferred Qualifications

• Knowledge of CPT, ICD‑10 coding, modifiers, and insurance specifications.
• Experience with electronic data interchange (EDI) and claim management systems such as Imagine.
• Familiarity with payer portals, carrier inquiry processes, and appeal workflows.
• Prior experience working in a remote or hybrid environment, demonstrating self‑discipline and time‑management.
• Certification in medical billing or coding (e.g., Certified Professional Biller, Certified Coding Associate).

Skills & Competencies

• Analytical Thinking: Ability to dissect complex denial reasons and devise effective resolution strategies.
• Attention to Detail: Precision in data entry, coding accuracy, and documentation for audit readiness.
• Customer‑Centric Mindset: Empathy for patients’ financial concerns and a proactive approach to problem‑solving.
• Collaboration: Working seamlessly with billing, coding, clinic staff, and leadership to achieve shared goals.
• Adaptability: Comfortable navigating evolving payer rules, technology updates, and workflow changes.
• Time Management: Prioritizing tasks based on deadlines, denial trends, and patient urgency.

Career Growth & Learning Opportunities

At brighthush, we believe in nurturing talent and providing clear pathways for advancement. As a Customer Service & Denial Specialist, you will have access to:

• Structured mentorship programs pairing you with senior billing and coding experts.
• Regular training workshops covering the latest payer regulations, coding updates, and technology enhancements.
• Cross‑functional projects that expose you to revenue cycle management, finance, and clinical operations.
• Opportunities to transition into specialized roles such as Revenue Cycle Analyst, Claims Auditor, or Billing Manager.
• Support for professional certifications and continuing education through tuition reimbursement and study resources.

Work Environment & Company Culture

brighthush offers a remote‑first work model that balances flexibility with a strong sense of belonging. Our culture is defined by:

• Inclusive teamwork: We celebrate diverse perspectives and encourage open dialogue.
• Transparent communication: Regular virtual town halls, Q&A sessions, and feedback loops keep everyone informed.
• Employee well‑being: Comprehensive health plans, mental health resources, and wellness Apply for this job