Associate, Healthcare Revenue Cycle Specialist – Disputes, Claims & Investigations
Stout · Posted Nov 5, 2026
- Washington, DC, United States
- Hybrid
- Full-time · Associate
- $74K–$135K per year
- 3+ years
Investigate complex hospital and health plan claims to understand how an account moves through billing, claim submission, adjudication, payment, denial, and appeal. Identify reimbursement and pricing discrepancies, research reasons for claim denials, and develop clear investigative reports and appeal narratives.
Compensation
A reasonable estimate of the current range is $74,000.00 - $135,000.00 Annual.
Responsibilities
- Trace disputed hospital and health plan claims through coding, billing, submission, payer edits, adjudication, payment posting, denials, recoupments, and appeals to establish the claim history.
- Investigate pricing and reimbursement discrepancies by comparing billed charges, payer contract terms, rate schedules, expected allowed amounts, and actual payments.
- Interpret provider agreements, reimbursement policies, and inpatient and outpatient payment methods, including DRG/APR-DRG, APC, case rates, fee schedules, and contractual carve-outs.
- Review UB-04/CMS-1450 and CMS-1500 claims, 837/835 transactions, explanations of benefits, remittance advices, account notes, and payment histories to reconcile claim-level evidence.
- Research denial and adjustment reasons using CARC/RARC codes, payer policies, coding guidance, denial letters, medical records, and prior appeal correspondence.
Requirements
- Bachelor's degree in Accounting
- Finance
- Health Information Management
- Healthcare Administration
- Business