Remote Medical Claims Examiner Jobs in Rio Grande, PR

Position Summary

Join Deloitte's AI & Engineering practice to support hospital denials management to deliver back-end Revenue Cycle Management (RCM) services, including Billing and Claims Submission, A/R Follow-up, Denials Management, Payment Posting, and Credits and Refunds, for health care provider client. This is a primarily remote role supporting enterprise Epic support, with minimal travel and scheduled onsite time as needed.

Recruiting for this role ends on 01/01/2027.

Work you'll do

As an Epic Denials Management Operator on the AI & Engineering team, you will be responsible for supporting review denials (835/277 processing) received from third party payers.

Conduct Denial categorization and root cause analysis based on remittance information received from payer. Review hospital account records and payer remittance records, communicate with relevant Client RCM and internal hospital stakeholders, and conduct outreach to payers through payer portals and phone calls to gather necessary information to understand denial reasons and root causes. Determine appropriate denial responses based on denial reasons. Use appropriate templates to develop denial appeal letters for denials and submit to third party payers. Rebill corrected claims and route issues to coding, billing, credentialing, denials, and/or clinical teams as needed. Provide additional documentation to payers as needed to resolve denial issues. Document denial details, research conducted, and follow-up activities conducted in relevant EMR and patient accounting systems. Review AR aging reports and work queues to identify unpaid and delayed claims. Follow up with third party payers on open denials, denial appeals, and other outstanding balances related to denials to understand claim status and payer requirements to adjudicate claim. Provide account information to payers and required and resolve issues related to eligibility, authorizations, claim edits, coordination of benefits, and missing documentation.

Adhere to defined SOPs and workflows and work within Epic Resolute Hospital Billing, claims clearinghouse, payer websites and portals, and other systems and required by workflows. Meet and exceed minimum productivity and quality standards; submit to performance improvement plans as required according to guidance from engagement management. A successful candidate would possess these skills:

• Ability to work independently and collaborate as part of a team
• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines

The team

AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements.

Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector.

Qualifications

Required:

• 2+ years of experience in hospital account denial management and appeals
• Experience using Epic Resolute Hospital Billing
• Bachelor's degree in information technology, business, healthcare, or a related field; or equivalent experience
• Experience working in claims clearinghouse systems
• Familiarity with Epic Analytics and Reporting applications
• Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve.
• Limited immigration sponsorship may be available.

Preferred:

• Experience using Microsoft Word, Excel, and PowerPoint
• Experience supporting clinical or healthcare business operations
• Experience managing multiple projects or workstreams
• Experience preparing and delivering technical demonstrations
• Experience analyzing billing workflows, claim issues, or operational data

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $70,000 to $90,000.

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.

Position Summary

Join Deloitte's AI & Engineering practice to support hospital denials management to deliver back-end Revenue Cycle Management (RCM) services, including Billing and Claims Submission, A/R Follow-up, Denials Management, Payment Posting, and Credits and Refunds, for health care provider client. This is a primarily remote role supporting enterprise Epic support, with minimal travel and scheduled onsite time as needed.

Recruiting for this role ends on 01/01/2027.

Work you'll do

As an Epic Denials Management Operator on the AI & Engineering team, you will be responsible for supporting review denials (835/277 processing) received from third party payers.

Conduct Denial categorization and root cause analysis based on remittance information received from payer. Review hospital account records and payer remittance records, communicate with relevant Client RCM and internal hospital stakeholders, and conduct outreach to payers through payer portals and phone calls to gather necessary information to understand denial reasons and root causes. Determine appropriate denial responses based on denial reasons. Use appropriate templates to develop denial appeal letters for denials and submit to third party payers. Rebill corrected claims and route issues to coding, billing, credentialing, denials, and/or clinical teams as needed. Provide additional documentation to payers as needed to resolve denial issues. Document denial details, research conducted, and follow-up activities conducted in relevant EMR and patient accounting systems. Review AR aging reports and work queues to identify unpaid and delayed claims. Follow up with third party payers on open denials, denial appeals, and other outstanding balances related to denials to understand claim status and payer requirements to adjudicate claim. Provide account information to payers and required and resolve issues related to eligibility, authorizations, claim edits, coordination of benefits, and missing documentation.

Adhere to defined SOPs and workflows and work within Epic Resolute Hospital Billing, claims clearinghouse, payer websites and portals, and other systems and required by workflows. Meet and exceed minimum productivity and quality standards; submit to performance improvement plans as required according to guidance from engagement management. A successful candidate would possess these skills:

• Ability to work independently and collaborate as part of a team
• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines

The team

AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements.

Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector.

Qualifications

Required:

• 2+ years of experience in hospital account denial management and appeals
• Experience using Epic Resolute Hospital Billing
• Bachelor's degree in information technology, business, healthcare, or a related field; or equivalent experience
• Experience working in claims clearinghouse systems
• Familiarity with Epic Analytics and Reporting applications
• Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve.
• Limited immigration sponsorship may be available.

Preferred:

• Experience using Microsoft Word, Excel, and PowerPoint
• Experience supporting clinical or healthcare business operations
• Experience managing multiple projects or workstreams
• Experience preparing and delivering technical demonstrations
• Experience analyzing billing workflows, claim issues, or operational data

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $70,000 to $90,000.

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.