Revenue Cycle Manager (Walnut Creek)

About the Company

Insight Global is seeking a fully remote Denials Specialist for our client specializing in orthopedic denials recovery.

About the Role

The RCM Denials Specialist is responsible for recovering revenue lost to denied and underpaid orthopedic medical claims by executing payer-specific denial recovery workflows with a high level of accuracy and efficiency. This role focuses on post-payment denials and unpaid claims, managing appeals from initial denial through final resolution. The specialist works within standardized playbooks and performance metrics to directly impact client cash flow and recovered revenue. This is a production-driven, outcomes-focused role suited for professionals who thrive in structured, KPI-driven environments and take ownership of financial results.

Responsibilities

Denial Recovery & Appeals
Work assigned denial and underpayment claim queues, including post-pay denials, medical necessity, bundling, timely filing, and workers’ compensation claims
Prepare, submit, and track appeals in accordance with payer- and CPT-specific guidelines
Follow up with insurance payers via phone, online portals, and written correspondence until final resolution
Ensure timely progression of claims and avoid preventable delays in follow-up

Documentation & Accuracy
Accurately document all claim actions, appeal submissions, and payer communications
Upload, organize, and maintain required clinical and billing documentation
Maintain clean, complete, and audit-ready records suitable for internal leadership and client review
Meet high accuracy standards while maintaining daily and weekly productivity targets

Workflow Execution & Collaboration
Adhere to standardized recovery playbooks and escalation thresholds
Escalate complex or unusual denial patterns appropriately
Collaborate with leadership, QA, and strategy teams to improve recovery outcomes
Identify and report payer trends, denial patterns, and workflow improvement opportunities

Qualifications

2+ years of experience in medical billing, accounts receivable (A/R), and/or denial recovery
Experience supporting orthopedic or specialty healthcare practices
Hands-on experience working insurance denials and appeals through resolution
Experience with commercial insurance payers (e.g., BCBS, Aetna, UnitedHealthcare, Cigna)
Strong attention to detail and commitment to documentation accuracy
Comfortable working in productivity- and metrics-driven environments
Work-from-home setup including a personal computer and wifi

Required Skills

Demonstrated success recovering high-dollar or complex denials
Prior experience in structured, high-performance revenue cycle teams
Familiarity with appeal success metrics, accuracy benchmarks, and throughput goals
Experience identifying payer trends or contributing to workflow optimization