Backend Claims Management Specialist

At EverCommerce [Nasdaq: EVCM], we are on a mission to digitally transform the service economy with tailored, end-to-end SaaS solutions that simplify and empower the lives of our 745,000+ customers.  As a leading service commerce platform, our modern digital and mobile applications create predictable, informed, and convenient experiences between customers and their service professionals in the areas of Home & Field Services, Health Services, and Wellness industries. 

We are building an extraordinary company and looking for talented, energetic, and motivated people to join our team. You can learn more about our Company, Culture and Values here: https://careers.evercommerce.com/us/en 

EverHealth, a business within EverCommerce, provides modern end-to-end solutions for healthcare providers. Our open, connected ecosystem of solutions and services helps providers engage patients, increase revenue, improve business efficiency, and remain market competitive. We serve 72,000 healthcare practices and counting. EverHealth consists of five SaaS products; DrChrono, iSalus, CollaborateMD, Updox, and MDTec, combined these products offer end to end solutions for the health care industry.

The Backend Claims Management Specialist enables timely claim resolution by providing operational expertise, strategic guidance, and educational support focused on backend revenue cycle performance. This role partners closely with Service Managers and BPO teams to identify barriers to payment, analyze denial trends, improve claim outcomes, and drive overall client health through data-driven recommendations. 

Key Responsibilities

Revenue Cycle & Claims Management

• Investigate and resolve complex claims, denials, and reimbursement issues.
• Analyze denial trends and identify root causes to improve claim outcomes.
• Support reduction of aged accounts receivable and optimize reimbursement performance.
• Escalate complex payer or operational issues as needed.

Payer & Operational Expertise

• Develop expertise in payer policies, reimbursement methodologies, and client workflows.
• Identify payer trends, emerging risks, and opportunities for process improvement.
• Partner with internal teams to implement solutions that improve operational efficiency and financial performance.

Customer Success & Performance Improvement

• Partner with Service Managers to improve overall client health and revenue cycle performance.
• Present findings, recommendations, and performance trends to internal stakeholders.
• Support client retention through proactive issue resolution and operational improvements.

Education & Collaboration

• Provide guidance and training to BPO teams on claims processing and denial prevention best practices.
• Develop and promote standardized processes that improve quality and consistency.
• Collaborate cross-functionally with Revenue Cycle, Operations, and Client Services teams to drive continuous improvement.

Qualifications

Required

• Experience in Revenue Cycle Management (RCM), medical billing, or healthcare claims management.
• Strong knowledge of claims processing, denial management, and payer reimbursement methodologies.
• Analytical mindset with the ability to identify trends, perform root cause analysis, and recommend solutions.
• Strong written and verbal communication skills with the ability to influence cross-functional teams.
• Proficiency in data analysis and performance reporting.

Preferred

• Experience in healthcare revenue cycle operations, denial prevention, appeals, or payer relations.
• Experience driving operational improvements and process optimization.

Success in This Role

Success in this role is measured by the ability to improve revenue cycle performance through reduced denials and aged receivables, increased clean claim rates, stronger client health, and the implementation of scalable operational improvements that enhance customer outcomes.

Where:

The EverCommerce team is distributed globally, with teams across multiple regions. This role can be based anywhere in the United States – if you’re close to one of our offices, we can set you up in-office or you can work 100% remotely. Please note that you must be eligible to work without sponsorship to qualify for this position, and this role may require occasional travel to our Corporate Headquarters in Denver, Colorado, or to other office locations within the United States.

Benefits and Perks: 

• Flexibility to work where/how you want within your country of employment – in-office, remote, or hybrid 
• Continued investment in your professional development 
• Day 1 access to a robust health and wellness benefits package, including an annual wellness stipend. 
• 401k with up to a 4% match and immediate vesting 
• Flexible and generous (FTO) time-off 
• Employee Stock Purchase Program 

Compensation:

The target base compensation for this position is $18 to $22 USD per hour in most US locations. Final offer amounts are determined by multiple factors including location, local market variances, and candidate experience and expertise, and may vary from the amounts listed above. 

EverCommerce is an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender identity, sexual orientation, age, marital status, veteran status, or disability status. We look forward to reviewing your credentials and getting to know more about your experience!

EverCommerce uses approved artificial intelligence (“AI”) tools to support its business operations. Employees are encouraged to use authorized AI tools, when appropriate for their roles, to improve efficiency, quality, and innovation. All AI use must comply with company policies, including requirements concerning confidentiality, data security, intellectual property, accuracy, and human review. Employees remain responsible for reviewing and validating AI-assisted work.