Insurance Specialist – Credit Resolution

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

📋 Description

• Evaluate accounts for credit balances and denials, identify root causes, and implement suitable corrective measures through refund, adjustment, rebill, or appeal.

• Analyze and resolve credit balances across all payers, giving priority to regulatory accounts such as Medicare credit balance reporting.

• Prepare and submit timely, precise appeals while processing credit resolutions in accordance with payer and regulatory standards.

• Ensure account activities facilitate progress towards resolution with a one-touch approach.

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

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

• Work collaboratively across departments to address issues and prevent future occurrences.

• Spot trends and escalate systemic problems, offering insights for process enhancement.

• Accurately and promptly initiate and monitor refunds, adjustments, and reapplications.

⛳️ Requirements

• High School Diploma or GED.

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

• A minimum of 2 years of Medical Billing/Follow-up experience.

• Experience in Rural Health Clinics and Critical Access Healthcare.

• Proficient with PC-based applications, including Microsoft Outlook, Word, and Excel.

• Download speed of 50MB or higher and upload speed of 20–25MB or higher.

• Access to a secure and private workspace where protected health information is not visible or audible to others.

• Must be legally authorized to work in the United States at the time of hire.

• Employment visa sponsorship is not available for this position.

• A pre-employment background check is required.

• Candidates residing in New York state cannot be considered.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Health Savings Account (HSA) and Flexible Spending Account (FSA) available.

• 401(k) plan with company match.

• Paid Wellness Time and Holidays.

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

• Opportunities for internal career advancement.