Claims Resolution Specialist at Innovative… · Indianapo…

About IHTC

At the Innovative Hematology (IHI), we offer a future where people with rare blood disorders flourish. Our experts provide the highest quality comprehensive services and holistic care to patients with bleeding, clotting and other hematologic disorders, and to their families.

What You Will Do

The Claims Resolution Specialist is a high-impact, project-based role designed to support the organization during a critical phase of revenue cycle transformation. This position offers the opportunity to contribute to enterprise-wide improvements in claims performance while demonstrating capability for potential long-term placement as organizational needs evolve.

This role is responsible for the end-to-end resolution of complex, high-dollar hemophilia-related insurance claims that have been denied, underpaid, or delayed by commercial, government, or specialty payers.

Serving as both an executional expert and a strategic contributor, the Claims Resolution Specialist leverages deep expertise in payer behavior, billing practices, and appeals strategy to drive claim resolution while identifying systemic trends and opportunities for upstream process improvement.

The ideal candidates will bring a strong analytical and problem-solving mindset, with the ability to operate effectively in an evolving environment. This individuals will play a key role in strengthening reimbursement outcomes, reducing denials, and informing the future-state design of revenue cycle operations.

The Opportunities

Level II

• Investigate, analyze, and resolve complex, high-dollar claims that have been denied, underpaid, or delayed, ensuring timely and accurate reimbursement
• Review and interpret payer denials to identify root causes (e.g., medical necessity, coding, authorization, coverage limitations, contractual discrepancies)
• Prepare and submit comprehensive, payer-specific appeal packages, including clinical documentation, medical necessity justification, and supporting evidence
• Interpret and apply payer policies, contracts, and regulatory requirements to support successful claim resolution and escalation strategies
• Collaborate cross-functionally with billing, clinical teams, specialty pharmacy, and providers to gather documentation and resolve barriers to payment
• Communicate effectively with payer representatives to advocate for reconsideration and drive resolution of complex claims
• Maintain accurate and detailed documentation of claim activity, appeal status, and payer interactions within claims management systems
• Monitor appeal timelines and ensure compliance with payer and regulatory requirements
• Identify denial trends and recurring issues, providing insights and recommendations to improve first-pass claim accuracy and reduce future denials
• Contribute to process improvement efforts by partnering with leadership and peers to enhance workflows, reduce rework, and strengthen revenue cycle performance
• Ensure compliance with organizational policies, payer requirements, and applicable federal and state regulations

Level I

• Retrieve, compile, and produce complete medical records and supporting documentation for denied insurance claims and formal appeals
• Coordinate the collection of clinical notes, treatment records, laboratory results, authorizations, referrals, physician orders, and other required materials from internal systems, providers, and external partners
• Ensure all documentation meets payer-specific requirements, formatting standards, and submission timelines
• Verify documentation accuracy, completeness, and consistency prior to submission to Claims Resolution Specialists or upload to payer portals
• Prepare and organize appeal packets according to established processes, including indexing, labeling, and secure transmission
• Track documentation requests, outstanding items, and submission deadlines to support timely appeal filing
• Maintain detailed records of documentation requests and submissions within claims management or document management systems
• Communicate effectively with internal departments such as clinical teams, medical records, billing, and pharmacy to obtain required materials
• Support audit readiness and compliance by adhering to HIPAA, data privacy policies, and organizational documentation standards