Claims Representative

Required Skills & Experience

• 3+ years of healthcare revenue cycle experience with a focus on insurance follow-up, denial management, or accounts receivable.
• Experience working denied and rejected claims from initiation through resolution.
• Knowledge of transplant billing processes, authorization requirements, and payer guidelines.
• Strong understanding of EOBs, remittance advice, claim edits, and appeals processes.
• Experience working within an EMR or billing system such as Epic, Cerner, or Meditech.
• Direct experience supporting solid organ and/or bone marrow transplant billing.

Nice to Have Skills & Experience

• Knowledge of Medicare, Medicaid, and commercial payer transplant reimbursement policies.
• Relevant certifications such as CRCR, CPB, or CPC.

Job Description

The Follow-Up Representative, Transplant Claims is responsible for managing denied and rejected transplant-related claims to ensure accurate reimbursement and timely resolution. This individual will investigate claim denials, identify root causes, and work directly with payers, transplant coordinators, and internal revenue cycle teams to secure payment. The representative will maintain detailed documentation, submit appeals when appropriate, and monitor accounts through resolution. Success in this role requires strong knowledge of transplant billing regulations, payer requirements, and denial management best practices.