Claims Representative (Healthcare Reimbursement)

Operations Gainesville, Virginia


Convergent Revenue Cycle Management Inc.

Claims Representative (Healthcare Reimbursement) – Gainesville, VA


Convergent employs a dedicated team of expert healthcare attorneys & Claims Representatives who navigate the entanglements of the legal system to increase reimbursement rates for our client hospitals all over the country. We apply our advanced technology to calculate anticipated payment for claims in states with complex fee schedules, allowing us to accurately identify and appeal underpaid or denied claims.  Our main goal is to assist hospital systems to strengthen their financial and clinical performance.  We are also a leading provider of denial management, Workers' Compensation claims resolution, and appeals solutions. 


Convergent’s Gainesville, VA office has openings for a Claims Representative.


  • Contact insurance companies, employer and/or patients by phone, mail or fax to resolve claims
  • Submit bills, with or without medical records or other documents, to insurance companies by mail, fax, or secure email
  • Group accounts by payer and make follow up calls as needed or submit electronic status inquires via spreadsheet
  • Prioritize high dollar account efforts with increased follow up activity
  • Access hospital systems to retrieve documents or information as needed or request information via a defined process, learn to save information securely and electronically
  • Learn the Artiva Collections System and its uses
  • Document the Artiva Collections System with all work efforts performed on each account, using correct spelling and grammar and updating account work flow, status code, and proper follow up date
  • Send and retrieve interoffice and/or external E-mail or regular mail
  • Follow protocols as outlined by the department for each program
  • Maintain confidentiality of patient information including medical records
  • Prioritize work schedule and organize desk and any correspondence
  • Meet daily productivity benchmarks and monthly financial goal(s)
  • Search internet databases for information on insurance company, employer and patient when applicable
  • Review state fee schedules or payer contracts to verify if the correct payment amounts were made by the payers; prepare and send appeals, as needed
  • Prepare appeals for other account denial issues, as needed
  • Perform other related duties as required



  • 2+ years’ experience in Healthcare reimbursement/medical collections is preferred
  • Strong analytical, problem-solving and conflict resolution skills
  • Excellent oral and written communication skills
  • Proficiency in Word and Excel is required
  • Basic knowledge of CPT & HCPCS coding language required, ICD-9 & ICD-10 knowledge a plus
  • Knowledge and understanding of UB04 and EOBs/RAs
  • Regular attendance is required
  • Remain in a stationary position 95% of the time
  • Occasionally move about inside the office to access office machinery etc.
  • Constantly operates a computer and other office productivity machinery (i.e. calculator, copy machine and computer printer).


Hiring is contingent upon successful background check and drug screening.

Compensation: negotiable based on experience