Claims Resolution Specialist

Job overview

The Claims Resolution Specialist role is onsite in Gainesville, FL. Compensation is not specified. The position supports the healthcare revenue cycle at Orthopedic Care Partners by helping ensure accurate and timely claim submission and resolution. The specialist investigates unpaid or denied claims, identifies recurring causes, and coordinates corrections and follow-up with payers and internal teams. This work supports reimbursement, compliance, and the organization’s financial health by improving claim resolution and helping reduce denials.

What you'll do

• Submit and track insurance and patient claims for government and commercial payers
• follow up on unpaid or denied claims
• analyze recurring denials and escalate trends
• research payer policies and claim requirements
• process write-offs and adjustments under established protocols
• document claim activities and communications
• collaborate with clinical, billing, and coding staff
• monitor aging reports and prioritize follow-up
• prepare reports on problem accounts and denial patterns
• assist with process improvements
• comply with HIPAA, payer guidelines, and internal billing policies.

What we're looking for

Skills & competencies

claims resolution specialist

orthopedic care partners

gainesville fl

healthcare revenue cycle

medical billing

claims follow-up

denial management

medicare

medicaid

commercial payers

hipaa

cpt/icd-10

ehr systems

Work arrangement

• Weekend coverage required

Why this role

The posting requires a high school diploma or equivalent and at least two years of medical billing, claims follow-up, or revenue cycle experience; orthopedic experience is preferred. Travel may be required to existing or new OCP locations.

About the employer

ORTHOPEDIC CARE PARTNERS is hiring for this role. Industry: Offices of Physicians (except Mental Health Specialists). Sector: 62.