Insurance Specialist (Remote) - Credit Resolution

Med A/Rx•Sartell, MN

5d•$20 - $22•Remote

About The Position

Insurance Specialists are highly focused on the resolution of insurance processing errors and denials and work to resolve hospital and physician billing challenges. You will utilize your expertise in patient billing, claims submission, and payer guidelines (Medicare, Medicaid, &, commercial insurers) to effectively work with insurance companies, resolve issues, and ensure accurate and timely payments. The role involves analyzing payer payments to identify underpayments and reimbursement discrepancies, interpreting and applying payer contract terms, conducting detailed account analysis to resolve complex denials and payment variances, and reviewing accounts for credit balances and denials to determine root cause and take appropriate corrective action. Specialists will submit timely appeals, process credit resolutions, and ensure all account activity supports forward movement toward resolution with a one-touch mindset. Maintaining thorough, audit-ready documentation and accurate account notes is crucial. The position requires meeting established productivity and quality standards, prioritizing high-risk accounts, and collaborating cross-functionally to resolve issues and prevent recurrence. Identifying trends and escalating systemic issues for process improvement is also a key responsibility. This is a remote position with a schedule of 7am - 4pm or 8am-5pm Central Time Zone, Monday – Friday. Paid training for 3 weeks is provided.

Requirements

High School Diploma/GED
Minimum of 3 years of experience in hands-on denials and credit resolution, with a proven ability to recover revenue from complex insurance denials and credits
2+ years of medical billing and follow-up experience
Rural Health Clinic and Critical Access Hospital experience
Strong analytical skills with the ability to interpret payer guidelines and payment data
Proficiency with PC-based applications (Microsoft Outlook, Word, and Excel)
Download speed of 30MB or higher and upload speed of 10MB or higher are required
Access to a secure and private workspace where protected health information may be viewed or discussed
Candidates must be legally authorized to work in the United States at the time of hire
The company does not provide employment visa sponsorship for this position
As a condition of employment, a pre-employment background check will be conducted

Nice To Haves

Experience working with Meditech systems or similar EHR/RCM platforms
Advanced knowledge of payer guidelines, reimbursement methodologies, and contract structures

Responsibilities

Analyze payer payments to identify underpayments and reimbursement discrepancies by comparing paid amounts to contracted rates, fee schedules, and expected reimbursement
Interpret and apply payer contract terms, guidelines, and reimbursement methodologies to ensure accurate payment outcomes
Conduct detailed account analysis using strong analytical skills and persistence to resolve complex denials and payment variances
Review accounts for credit balances and denials, determine root cause, and take appropriate corrective action (refund, adjustment, rebill, or appeal)
Review and resolve credit balances across all payers, with priority on regulatory accounts (e.g., Medicare credit balance reporting)
Submit timely, accurate appeals and process credit resolutions in alignment with payer and regulatory guidelines (including Medicare credit balance requirements)
Ensure all account activity supports forward movement toward resolution with a one-touch mindset
Maintain thorough, audit-ready documentation and accurate account notes
Meet established productivity (APH) and quality standards while prioritizing high-risk, high-dollar, and timely filing accounts
Collaborate cross-functionally to resolve issues and prevent recurrence
Identify trends and escalate systemic issues, providing feedback for process improvement
Initiate and track refunds, adjustments, and reapplications accurately and timely