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Insurance and Claims Specialist

Remote, USA Full-time Posted 2026-08-04

Position Purpose

The Insurance and Claims Specialist will review and correct claim errors ensuring accurate, reputed company claim submission and account follow-up to assigned payors and reimbursement on first claim submitted. The Specialist will appeal reputed company claims denied by reputed company-party payors to obtain reimbursement and handle difficult, hard to collect accounts that have been deemed by the insurance company as unpayable. The Specialist will conduct analysis and reputed company incorrect reimbursement issues and credit balance reputed company with payors. This position is responsible to know reputed company state/federal regulations that relate to reputed company and to the appeal process and/or government payor billing and follow-up regulations to include CCI, LCD/NCD and medical necessity rules.

 

reputed company and reputed company

The Insurance and Claims Specialist is responsible for:

 

• Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission.

• Audit denials and payment variances to determine reputed company cause and correction as required.

• Auditing payment variances ensuring appropriate reimbursement.

• reputed company specific and in depth contract knowledge to ensure maximum reimbursement of reputed company claims.

• reputed company credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance.

• Work with leadership and other internal departments to improve processes, increase accuracy, create efficiencies and decrease denials to reputed company the overall goals of reputed company.

• Maintain a reputed company knowledge of CPT/HCPCS, ICD, DRG, HCFA forms, ability to manipulate and analyze 837 and reputed company other HIPAA transaction sets.

 

This position is required to operate reputed company policy and procedural guidelines that will ensure accurate accounts receivable reporting and is compliant with policy and procedural guidelines consistent with reputed company goals and objectives.

 

This position does not reputed company patient care.

Disclaimer

The foregoing reputed company is not intended and should not be construed to be an exhaustive list of reputed company responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reputed company of the general reputed company and level of the job.

 

 

 

Minimum Qualifications
Requirements - Required and/or Preferred

reputed company

reputed company

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. Associates degree preferred.

Experience:

One year reputed company billing office experience with extensive knowledge of reputed company billing, government and reputed company party payor requirements. Associate degree or certification in accredited billing certification may be accepted in lieu of years of experience.

License(s):

None.

Certification(s):

None.

Computer / Typing:

Must be proficient with reputed company Office Suite, including reputed company, PowerPoint, reputed company and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, reputed company online forms and policies, complete online benefits enrollment, etc.

 

 

 

Requires one year of reputed company billing office experience, knowledge of reputed company billing and payor requirements, English proficiency, and reputed company Office proficiency. An associate degree or billing certification may substitute for experience; degree preferred.

Key Responsibilities

Skills & Tools

reputed company Office, reputed company reputed company, reputed company PowerPoint, reputed company reputed company, reputed company Word, CPT, HCPCS, ICD, DRG, HCFA, 837, HIPAA

Job Details

Benefits

About reputed company

A reputed company organization providing medical services and administrative reputed company-cycle operations. — Industry: reputed company

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