Revenue Cycle Manager

About the CompanyInsight Global is seeking a fully remote Denials Specialist for our client specializing in orthopedic denials recovery.About the RoleThe 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.ResponsibilitiesDenial Recovery & AppealsWork assigned denial and underpayment claim queues, including post-pay denials, medical necessity, bundling, timely filing, and workers’ compensation claimsPrepare, submit, and track appeals in accordance with payer- and CPT-specific guidelinesFollow up with insurance payers via phone, online portals, and written correspondence until final resolutionEnsure timely progression of claims and avoid preventable delays in follow-upDocumentation & AccuracyAccurately document all claim actions, appeal submissions, and payer communicationsUpload, organize, and maintain required clinical and billing documentationMaintain clean, complete, and audit-ready records suitable for internal leadership and client reviewMeet high accuracy standards while maintaining daily and weekly productivity targetsWorkflow Execution & CollaborationAdhere to standardized recovery playbooks and escalation thresholdsEscalate complex or unusual denial patterns appropriatelyCollaborate with leadership, QA, and strategy teams to improve recovery outcomesIdentify and report payer trends, denial patterns, and workflow improvement opportunitiesQualifications2+ years of experience in medical billing, accounts receivable (A/R), and/or denial recoveryExperience supporting orthopedic or specialty healthcare practicesHands-on experience working insurance denials and appeals through resolutionExperience with commercial insurance payers (e.g., BCBS, Aetna, UnitedHealthcare, Cigna)Strong attention to detail and commitment to documentation accuracyComfortable working in productivity- and metrics-driven environmentsWork-from-home setup including a personal computer and wifiRequired SkillsDemonstrated success recovering high-dollar or complex denialsPrior experience in structured, high-performance revenue cycle teamsFamiliarity with appeal success metrics, accuracy benchmarks, and throughput goalsExperience identifying payer trends or contributing to workflow optimization