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.

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: 

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:

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. 

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