Insurance Specialist (Remote) - Credit Resolution
About Us:
Meduit is a national leader in healthcare revenue cycle management, supporting hospitals and physician practices in 48 states. We focus on optimizing payments, allowing clients to focus on patient care, and pride ourselves on our core values: Integrity, Teamwork, Continuous Improvement, Client-Focused, and Results-Oriented. Learn more at www.meduitrcm.com.
About the Role:
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.
Title: Insurance Specialist - Denials Resolution
Schedule: 7am - 4pm or 8am-5pm Central Time Zone, Monday – Friday
Location: Remote
Paid Training: 3 weeks
Compensation: $20 - $22 per hour base, depending on qualifications
Key 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
Skills & Competencies:
Integrity
Communication
Problem-solving
Teamwork
Required Qualifications:
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 (https://speedtest.net/)
Access to a secure and private workspace where protected health information may be viewed or discussed
Preferred Qualifications:
Experience working with Meditech systems or similar EHR/RCM platforms
Advanced knowledge of payer guidelines, reimbursement methodologies, and contract structures
Employment eligibility:
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
At this time, we are unable to consider candidates residing in the state of New York for this position
What We Offer:
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
Meduit is an Equal Opportunity Employer. We do not discriminate based on any protected class and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
#LI-Remote
Meduit is a national leader in healthcare revenue cycle management, supporting hospitals and physician practices in 48 states. We focus on optimizing payments, allowing clients to focus on patient care, and pride ourselves on our core values: Integrity, Teamwork, Continuous Improvement, Client-Focused, and Results-Oriented. Learn more at www.meduitrcm.com.
About the Role:
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.
Title: Insurance Specialist - Denials Resolution
Schedule: 7am - 4pm or 8am-5pm Central Time Zone, Monday – Friday
Location: Remote
Paid Training: 3 weeks
Compensation: $20 - $22 per hour base, depending on qualifications
Key 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
Skills & Competencies:
Integrity
Communication
Problem-solving
Teamwork
Required Qualifications:
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 (https://speedtest.net/)
Access to a secure and private workspace where protected health information may be viewed or discussed
Preferred Qualifications:
Experience working with Meditech systems or similar EHR/RCM platforms
Advanced knowledge of payer guidelines, reimbursement methodologies, and contract structures
Employment eligibility:
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
At this time, we are unable to consider candidates residing in the state of New York for this position
What We Offer:
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
Meduit is an Equal Opportunity Employer. We do not discriminate based on any protected class and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
#LI-Remote