Medical Claims Insurance Specialist - Remote

The Little Clinic in; Nashville (TN); Remote; USD 40,000 - 55,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Claims Insurance Specialist to work remotely. The ideal candidate will have experience with revenue cycle management and insurance follow-up, including the ability to analyze and resolve claims discrepancies. Responsibilities include reviewing payer correspondence, submitting appeals for denied claims, and ensuring timely payments. This role requires strong communication skills and attention to detail, and offers opportunities for professional growth in a supportive team environment.

Qualifications

• 1+ year of insurance follow-up experience required.
• Thorough knowledge of revenue cycle management and medical terminology.
• Must be highly self-motivated and able to work independently.

Responsibilities

• Analyze and resolve claims outstanding or incorrectly paid.
• Review and respond to payer correspondence.
• Document all actions taken in the accounts receivable system.

Skills

Strong written and oral communication skills

Analytical and problem-solving capabilities

Attention to detail

Excellent organizational skills

Ability to navigate payer websites

Education

High school diploma

Job description

Medical Claims Insurance Specialist - Remote (Finance)

Possess a thorough working knowledge of the revenue cycle management process. Responsible for the research and resolution of aging account receivables that are either unpaid or incorrectly paid. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety.

Minimum Position Qualifications:

• High school diploma
• 1+ year of insurance follow-up including working knowledge of the appeals resolution process
• Strong written and oral communication skills
• Analytical and problem-solving capabilities with close attention to detail
• Excellent organizational and follow-up skills
• Thorough working knowledge of revenue cycle management including medical terminology, ICD-9, ICD-10, CPT-4 coding, Medicare reimbursement guidelines, billing, and collection practices
• Ability to read and interpret EOBs
• Highly self-motivated, with the ability to work independently and meet deadlines
• Ability to remain flexible during times of change and adjust promptly and effectively
• Must be able to learn, understand, and apply new technologies

• Analyze, audit, and resolve claims outstanding, denied, or incorrectly paid
• Review and respond to payer correspondence
• Submit appeals as needed for denied claims
• Contact insurance companies and navigate payer websites to secure and expedite insurance payments
• Resolve patient billing inquiries
• Document in detail all actions taken in the accounts receivable system
• Meet productivity expectations as outlined by supervisor
• Recognize, document, and notify Team Lead of trends resulting in nonpayment or incorrectly paid claims
• Answer and resolve inbound calls from insurance carriers
• Participate in process improvement initiatives as needed
• Keep current with Medicare and other third-party administrator regulations and procedures
• Manage any special projects requested by supervisor or team lead
• Must be able to perform the essential functions of this position with or without reasonable accommodation