Claims Resolution Manager

Job Description

Job Description

Company Overview :

Upward Health is an in-home, multidisciplinary medical group providing 24 / 7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It's no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description :

The Claims Resolution Manager leads the end-to-end process of resolving outstanding and denied medical claims. This role ensures timely reimbursement, compliance with payer requirements, and optimal revenue cycle performance. The ideal candidate is a problem solver who blends deep knowledge of healthcare revenue cycle operations with team-building and payer relationship skills.

Key Responsibilities :

• Claims Oversight & Resolution

Direct and manage the claims resolution team to ensure prompt follow-up on unpaid, denied, or underpaid claims.

Establish and monitor key performance indicators (KPIs) such as days in A / R, denial rate, and cash collections.

Ensure all activities comply with federal and state regulations, payer contracts, and HIPAA requirements.

Recruit, train, and mentor claims resolution staff.

Qualifications :

Advanced Microsoft Excel proficiency, including pivot tables, v-lookups, and complex formula building for data analysis and reporting.

Key Competencies :

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

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