Medical Claims Insurance Specialist - Remote

The Little Clinic; Nashville (TN); Remote; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking a detail-oriented individual to join their team in revenue cycle management. This role involves analyzing and resolving claims, ensuring timely payments, and maintaining strong communication with insurance providers. The ideal candidate will demonstrate strong analytical and organizational skills, with a commitment to excellence and the ability to adapt in a fast-paced environment. Join a company that values respect, integrity, and teamwork, and contribute to improving patient billing processes while enhancing your professional growth.

Qualifications

• 1+ year of experience in insurance follow-up and appeals resolution.
• Thorough knowledge of revenue cycle management and medical terminology.

Responsibilities

• Analyze and resolve outstanding or denied claims with attention to detail.
• Contact insurance companies to expedite payments and resolve inquiries.

Skills

Insurance Follow-up

Analytical Skills

Communication Skills

Organizational Skills

Revenue Cycle Management

Problem-solving

Attention to Detail

Education

High School Diploma

Job description

Job Description

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

Key Responsibilities:

• Analyze, audit, and resolve claims that are 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 all actions taken in the accounts receivable system in detail
• 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
• Stay current with Medicare and other third-party administrator regulations and procedures
• Manage any special projects requested by supervisor or team lead
• Perform the essential functions of this position with or without reasonable accommodation