Insurance Specialist – Credit Resolution

This is a fully remote position, open to applicants in Minnesota.

📋 Description

• Evaluate payer payments to detect underpayments and discrepancies in reimbursements by comparing received amounts with contracted rates, fee schedules, and anticipated reimbursements.

• Interpret and apply payer contract specifications, guidelines, and reimbursement methodologies to guarantee accurate payment results.

• Perform in-depth account analyses utilizing strong analytical skills and determination to address complex denials and payment discrepancies.

• Examine accounts for credit balances and denials, identify root causes, and implement appropriate corrective measures (refunds, adjustments, rebills, or appeals).

• Review and resolve credit balances across all payers, prioritizing regulatory accounts (e.g., Medicare credit balance reporting).

• Submit precise and timely appeals and handle credit resolutions in accordance with payer and regulatory standards (including Medicare credit balance criteria).

• Ensure all account activities contribute to progress toward resolution with a one-touch approach.

• Maintain comprehensive, audit-ready documentation and precise account notes.

• Achieve established productivity (APH) and quality benchmarks while focusing on high-risk, high-dollar, and timely filing accounts.

• Work collaboratively across functions to address issues and prevent recurrence.

• Recognize trends and escalate systemic problems, offering feedback for process enhancements.

• Initiate and monitor refunds, adjustments, and reapplications accurately and promptly.

⛳️ Requirements

• High School Diploma/GED.

• At least 3 years of hands-on experience in denials and credit resolution, demonstrating a successful track record of recovering revenue from intricate insurance denials and credits.

• Over 2 years of experience in medical billing and follow-up.

• Experience in Rural Health Clinics and Critical Access Hospitals.

• Strong analytical abilities with the capacity to interpret payer guidelines and payment information.

• Proficiency in PC-based applications (Microsoft Outlook, Word, and Excel).

• Required internet download speed of 30MB or higher and upload speed of 10MB or higher.

• Access to a secure and private workspace where protected health information can be viewed or discussed.

🏝️ Benefits

• Comprehensive paid training.

• Medical, dental, and vision insurance.

• HSA and FSA options available.

• 401(k) plan with company matching.

• Paid Wellness Time and Holidays.

• Employer-paid life insurance and long-term disability coverage.

• Opportunities for internal growth.