Medical Insurance Collections Specialist

AIS Healthcare • Remote,

1d • Remote

About The Position

AIS Healthcare is seeking an experienced Medical Insurance Collection Specialist to join its Financial Services team. The role manages collection activities related to Targeted Drug Delivery (TDD) services, including reimbursement follow-up, denial management, appeals, payment investigation, account resolution, and communication with insurance carriers and other responsible parties to secure timely payment for services rendered.

The specialist uses healthcare collections experience and knowledge of insurance reimbursement processes to independently resolve complex account issues while complying with federal and state regulations, payer requirements, and company policies. The position is 100% remote and calls for collaboration, accountability, and detailed documentation.

Requirements

• High school diploma or GED.
• 3–5 years of healthcare industry experience.
• 3–5 years of medical billing and insurance collections experience.
• Strong understanding of healthcare reimbursement and collection processes.
• Experience with denial management and appeals.
• Ability to analyze and resolve complex reimbursement issues.
• Knowledge of insurance plans, medical terminology, billing procedures, and healthcare regulations.
• Excellent verbal and written communication skills.
• Strong attention to detail and organizational skills.
• Ability to work independently in a remote environment.
• Proficiency in Microsoft Outlook, Word, and Excel.

Nice To Haves

• Home Infusion experience.
• Intrathecal Pain Management experience.
• Specialty Pharmacy experience.
• Experience working with infusion therapies and reimbursement models.
• Knowledge of NDC numbers and infusion-related supplies.
• Understanding of payer contracts and reimbursement methodologies.

Responsibilities

• Follow up on submitted claims and invoices to ensure prompt and accurate reimbursement.
• Investigate and resolve denied, underpaid, unpaid, duplicate, and overpaid claims.
• Analyze payments and denials for accuracy and proper application.
• Research and resolve billing and reimbursement discrepancies.
• Initiate and manage appeals to maximize reimbursement opportunities.
• Process account adjustments, write-offs, and refund requests according to company policies.
• Collaborate with internal departments to obtain information needed for payment resolution.
• Maintain detailed documentation of collection activities and insurance carrier communications.
• Contact insurance companies to troubleshoot payment issues and establish resolutions.
• Resolve denial issues within established turnaround times.
• Ensure compliance with HIPAA, federal regulations, payer requirements, and company policies.
• Identify opportunities to improve reimbursement and reduce outstanding accounts receivable.
• Maintain knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
• Develop a working knowledge of NDC numbers, metric quantities, and infusion-related supplies.
• Share knowledge and best practices with team members to support department success.

Benefits

• Medical insurance.
• Dental insurance.
• Vision insurance.
• Company-paid life insurance.
• Long-term disability insurance.
• Generous paid time off.
• 401(k) with generous employer match.
• Career growth opportunities.
• Supportive and collaborative team environment.
• 100% remote work opportunity.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED