Claims Resolution Manager

Position Title : Claims

Resolution

Manager

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. Its 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.

Analyze payer

trends to identify root causes of denials and implement proactive

corrective actions.

Oversee appeals,

resubmissions, and secondary claims to maximize

recoveries.

Process &

Performance Management

Establish and monitor

key performance indicators (KPIs) such as days in A / R, denial rate,

and cash collections.

Develop standardized

workflows and best practices to drive efficiency and

accuracy.

Partner with Revenue Cycle, Coding,

and Clinical Operations teams to prevent rework and reduce

avoidable

denials.

Compliance &

Payer Relations

Ensure all activities comply

with federal and state regulations, payer contracts, and HIPAA

requirements.

Serve as the escalation point for

payer disputes and foster strong relationships with payers to

facilitate timely

resolution.

Leadership

& Collaboration

Recruit, train, and mentor

claims resolution staff.

Collaborate with

Finance, Technology, and Market Operations to support company-wide

revenue cycle

initiatives.

Qualifications : Experience :

5+ years in medical claims resolution, revenue cycle management, or

payer operations, with at least 2 years in a leadership or

supervisory

capacity.

Knowledge :

Expertise in Medicare, Medicaid, and commercial payer rules,

including value-based and risk-bearing

arrangements.

Skills : Advanced

Microsoft Excel proficiency, including pivot tables, v-lookups, and

complex formula building for data analysis and

reporting.

Strong analytical and

problem-solving abilities.

Excellent

communication and negotiation

skills.

Proficiency in EHR / PM and claims

management

systems.

Preferred :

Experience with Salesforce Health Cloud and Athenahealth (Athena)

practice management / EHR

systems.

Education :

Bachelors degree in healthcare administration, finance, or related

field (or equivalent

experience).

Key

Competencies : Results-oriented

with a continuous improvement mindset.

Skilled

at interpreting complex payer policies and regulatory

guidance.

Team-oriented leader who models

integrity and accountability.

Ability to thrive

in a fast-growing, mission-driven healthcare

organization.

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.

Upward Health Benefits

Upward Health Core Values

Upward Health YouTube Channel

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