Insurance Specialist – Credit Resolution

🕒 Ontem

❄️ Minnesota – Remoto

❄️ Minnesota – Remote

💵 $20 - $22 / hora

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🔒 Seguros

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Meduit | Driving Revenue Cycle Performance

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2017

⚕️ Seguro de Saúde

🤖 Inteligência Artificial

☁️ SaaS

Healthcare Insurance • Artificial Intelligence • SaaS

Meduit | Impulsionando o Desempenho do Ciclo de Receita é uma empresa de gestão de ciclo de receita (RCM) na área da saúde, orientada pela tecnologia, que combina a expertise em RCM com IA, automação de processos robóticos, análises preditivas e ferramentas de engajamento do paciente para otimizar o fluxo de caixa, reduzir recusas e melhorar a satisfação do paciente para hospitais, sistemas de saúde e grandes práticas. Seus serviços incluem soluções pré-serviço, pré-registro centralizado, financiamento de pacientes, serviços de escritório de negócios, resolução de recusas, cobrança e acompanhamento, liquidação de contas a receber antigas, serviços de reembolso governamental e ofertas de IA como MeduitAI™, automação conversacional e robótica SARA, pré-autorização automatizada e acompanhamento de sinistros. A Meduit também oferece consultoria, relatórios e análises, staffing, recuperações especializadas e serviços completos de escritório de negócios para ajudar os provedores a acelerar a receita e mitigar desafios operacionais.

Descrição

• 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

🎯 Requisitos

• 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

🏖️ Benefícios

• 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