Chiropractic Claims Resolution Specialist

Position Overview

Twin Creeks Health is seeking a detail-oriented Chiropractic Claims Resolution Specialist to manage insurance claims and resolve billing issues related to chiropractic and rehabilitative healthcare services.

This position will monitor claims from submission through payment, investigate denials and rejections, communicate with insurance carriers, correct billing discrepancies, and follow up on outstanding reimbursements. The specialist will work closely with providers, billing staff, patients, and insurance representatives to help maintain an accurate and efficient revenue cycle.

Key Responsibilities

Claims Management

• Prepare, submit, and monitor insurance claims for chiropractic and related healthcare services.
• Review claim status, payment activity, rejections, denials, and outstanding balances.
• Track claims from initial submission through final resolution.
• Identify missing, inconsistent, or incorrect claim information.
• Maintain accurate claim notes and follow-up documentation.
• Prioritize claims based on aging, payer requirements, and financial impact.

Denial & Rejection Resolution

• Research denied, rejected, and underpaid claims to determine the cause of the issue.
• Review payer explanations of benefits, remittance information, and claim correspondence.
• Correct administrative and billing errors when appropriate.
• Coordinate with providers and billing personnel to obtain missing documentation or information.
• Prepare and submit corrected claims or appeals according to payer requirements.
• Track appeals and disputed claims through resolution.

Insurance & Payer Follow-Up

• Contact insurance carriers regarding unpaid, delayed, denied, or underpaid claims.
• Verify claim status and document payer responses.
• Follow up on outstanding requests for records, authorizations, referrals, or additional information.
• Maintain accurate records of payer correspondence and follow-up dates.
• Escalate recurring or complex payer issues to management.

Chiropractic Billing Support

• Review billing information for chiropractic services for administrative completeness.
• Assist with identifying discrepancies involving procedure codes, diagnosis information, modifiers, units, dates of service, or payer requirements.
• Coordinate with clinical and billing teams when additional documentation is required.
• Monitor issues related to authorization, referral, medical-necessity documentation, or visit limits.
• Support accurate billing practices while following established organizational procedures.

Accounts Receivable

• Monitor outstanding insurance receivables and aging reports.
• Follow up on unpaid claims according to established collection timelines.
• Assist with identifying high-priority accounts and aging trends.
• Research payment discrepancies and potential underpayments.
• Support reconciliation of payer payments and outstanding balances.

Patient Account Support

• Assist with patient questions related to insurance billing, claim status, balances, deductibles, and explanations of benefits.
• Communicate billing information clearly and professionally.
• Escalate complex coverage or clinical questions to the appropriate staff member.
• Maintain confidentiality when handling patient health and financial information.

Documentation & Records

• Maintain accurate electronic claim and billing records.
• Document all payer and patient communications.
• Organize supporting documentation for corrected claims and appeals.
• Maintain claim follow-up logs and resolution records.
• Assist with billing audits and revenue-cycle reporting.

Reporting & Process Improvement

• Prepare routine reports regarding claim status, denials, aging, and reimbursement.
• Identify recurring denial and rejection patterns.
• Recommend administrative improvements to reduce preventable claim issues.
• Assist with developing claim follow-up procedures and tracking tools.
• Communicate significant reimbursement trends to management.

Qualifications

Required

• High school diploma or equivalent.
• 2+ years of experience in medical billing, chiropractic billing, insurance claims, accounts receivable, or healthcare revenue cycle.
• Strong knowledge of insurance claims and reimbursement processes.
• Excellent attention to detail.
• Strong written and verbal communication skills.
• Ability to research and resolve complex billing issues.
• Strong organizational and follow-up skills.
• Proficiency with computers, spreadsheets, billing systems, and payer portals.

Preferred

• Previous experience in a chiropractic, physical therapy, rehabilitation, pain management, or similar healthcare practice.
• Experience handling chiropractic claims and payer requirements.
• Familiarity with common chiropractic CPT/HCPCS and diagnosis coding terminology.
• Experience with claim appeals and corrected claims.
• Knowledge of Medicare, Medicaid, workers' compensation, personal injury, and commercial insurance claims.
• Experience with electronic health records and practice-management systems.
• Familiarity with HIPAA and healthcare privacy requirements.

Core Competencies

• Chiropractic claims management
• Denial resolution
• Insurance follow-up
• Appeals coordination
• Accounts receivable
• Payment reconciliation
• Payer communication
• Billing accuracy
• Documentation management
• Problem solving
• Organization
• Attention to detail
• Patient service
• Confidentiality

Pay: $24.64 - $29.68 per hour

Benefits:

• 401(k)
• Flexible schedule
• Health insurance
• Paid time off
• Professional development assistance

Work Location: Remote