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

🤝 B2B

🤖 Inteligência Artificial

☁️ SaaS

B2B • Artificial Intelligence • SaaS

Meduit | Impulsionando o Desempenho do Ciclo de Receita é uma empresa de gestão de ciclo de receita na área da saúde que combina operações especializadas de RCM com inteligência artificial, automação de processos robóticos e análises avançadas para ajudar hospitais, sistemas de saúde e grandes práticas médicas a acelerar o fluxo de caixa, reduzir negações de reivindicações e melhorar a experiência de pagamento dos pacientes. A empresa oferece serviços completos — pré-registro, faturamento e acompanhamento, resolução de negações, escritório comercial estendido, redução de contas a receber antigas, recuperação de dívidas incobráveis, recrutamento e consultoria — juntamente com ofertas de tecnologia, incluindo MeduitAI™, SARA (uma assistente autônoma de receitas supervisionada), análises preditivas e automação de conversação/pagamento.

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