Insurance Specialist – Credit Resolution
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Job Description
Insurance Specialist resolving insurance processing errors and denials at Meduit. Utilizing expertise in patient billing and claims submission to ensure accurate and timely payments.
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
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
Benefits:
- Comprehensive paid training
- Medical, dental, and vision insurance
- HSA and FSA available
- 401(k) with company match
- Paid Wellness Time and Holidays
- Employer paid life insurance and long-term disability
- Internal growth opportunities
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