Resolution Specialist in Alameda, California at Aspirion

About Aspirion

At Aspirion, our mission is simple and meaningful: to help healthcare providers get paid accurately, quickly, and transparently for the care they deliver. By combining deep human expertise with advanced technology and AI, we are helping make healthcare more affordable and accessible for everyone.

For more than two decades, Aspirion has been a market leader in revenue cycle services, specializing in some of the most complex and high impact areas of reimbursement. From challenging denials and zero balance reviews to aged accounts receivable, motor vehicle accident claims, workers’ compensation, Veterans Affairs, and out of state Medicaid, we take on the work that others cannot solve and deliver real results for our clients. At the heart of that success is our team. Our teammates are the foundation of everything we do. With more than 1,400 individuals across the organization, we are united by a shared commitment to delivering exceptional outcomes and creating meaningful impact for the hospitals and health systems we serve.

We are building a results driven environment where high performance, collaboration, and continuous growth are expected and supported. The people who thrive here bring a growth mindset, stay open to new technology, and collaborate across teams to solve problems. You will have the opportunity to work alongside a talented and driven team, engage with innovative technology, and play a direct role in solving complex challenges that matter.

Joining Aspirion means more than taking a job. It means being part of a team that is shaping the future of healthcare operations while making a measurable difference for providers and patients alike.

About the Role

Impact you will make

We are seeking an engaged and driven Follow-Up Representative for our Zero Balance team. A successful Resolution Specialist will support the success of a high-volume, fast paced revenue cycle process by helping to follow up on accounts in a timely manner, navigate independently through multiple applications, payer portals and other websites, express critical thinking in independent work, and demonstrate high capabilities of computer literacy when independently troubleshooting issues or working with tech support.

What you will do

• Complete appropriate actions needed for timely claims follow up and effective appeals submission including research, rebilling, adjustments, transfers to next responsible parties, and escalating payer issues to Leadership
• Correspond professionally with third party commercial insurance payers to obtain information required for effective claims resolution
• Use provided references materials to troubleshoot claims issues and increase understanding of claims resolution techniques. Reference payer websites as needed
• Utilize payer portals and internal systems to support account follow-up and resolution activities.
• Navigate payer guidelines and reimbursement workflows to support accurate claims resolution
• Review and analyze payer, IPA, and medical group responsibility for underpayments and denials based on DOFR and capitated agreement structures
• Communicate and collaborate well with other team members
• Complete assigned work queues or tasks within timeframes assigned by Leadership

What you will bring

• Working knowledge of EOBs, EFTs and ERAs, patient liabilities, and insurance or third-party correspondences
• Strong facility-based revenue cycle background with experience navigating underpayments, denials, payer follow-up, and reimbursement workflows required
• Facility or hospital billing experience required; professional billing only experience is not ideal
• Understanding of medical terminology, payer responsibility determination, and claims resolution processes required
• Demonstrated ability to adapt within a high volume, fast paced revenue cycle team
• Demonstrated ability to interpret EOBs, denials, and appeals
• Demonstrated ability to efficiently call insurance payers
• Ability to utilize websites and payer portals when applicable
• Express critical thinking in independent work
• Demonstrate high capabilities of computer literacy
• Adaptability and ability to work with a diverse team and client base
• Ability to work within deadlines while remaining flexible and organized
• Excellent communication, both written, verbal and demonstrated listening skills
• Ability to learn within a 100% remote environment
• Secure working location with no interruptions during working hours
• High proficiency with standard office equipment and software such as Microsoft Office products, knowledge of Health Information Systems, 10-key, multi-line telephone
• Ability to identify financially responsible parties across payer, IPA, and medical group structures
• High school diploma or equivalent

What we would like to see

• Bachelor's degree preferred
• Healthcare billing knowledge preferred
• Previous experience supporting facility-based payment variance, denial resolution, or appeals processes preferred
• Familiarity with California healthcare reimbursement guidelines and managed care structures preferred
• Previous experience working within Epic and payer portal systems preferred
• Experience reviewing contracts, reimbursement matrices, and appeal submissions preferred
• Knowledge of IPAs, medical groups, capitated agreements, and DOFR (Division of Financial Responsibility) preferred
• Familiarity with California-specific payers and guidelines including IEHP, CCS, Aetna, Regal Medical Group, Molina, Kaiser, and Blue Cross preferred
• California payer and medical group/IPA experience preferred
• Facility or hospital healthcare billing knowledge strongly preferred
• Previous work from home experience preferred

Core expectations

• Demonstrate integrity and ethics in day-to-day tasks and decision making, operate effectively in the environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
• Support Compliance Program by adhering to policies and procedures pertaining to HIPAA, GLBA, FCRA, and other laws applicable to business practices; this includes becoming familiar with Code of Ethics, attending training as required, notifying management when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations
• US remote-based colleagues are not permitted to work from a location outside of the United States, at any time, without prior, written approval

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

After orientation and training is complete, flexible scheduling is available between 6:30 AM – 6:30 PM EST based on business needs, project demands, training completion, and demonstrated ability to work independently.

Disclaimer

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. This position may be required to perform other duties. If such work becomes a permanent and regular part of the job, a new description will be prepared. Teammates must be logged in by 8:30AM in their time zone and work an 8 hour shift.

Aspirion is an Equal Opportunity Employer and does not discriminate on the basis of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, gender identity, military veteran status, or any other characteristic protected by law.