Revenue Cycle Specialist - Remote

Overview

MedScope, a division of Medical Guardian, is a rising leader in the medical alarm industry, seeking a seasoned Revenue Cycle Specialist with health insurance claims experience to fill a role in the Revenue Cycle Department. The Revenue Cycle Specialist is responsible for managing an assigned book of business consisting of Medicaid payers to ensure accurate and timely reimbursement for healthcare services. This role focuses on claim follow-up, denial resolution, payer correspondence, and ensuring compliance with payer-specific guidelines. The specialist serves as the primary point of contact for assigned payer accounts and works to resolve outstanding balances through proactive follow-up and problem-solving. Ability to analyze data and think critically is a must.

In Short

• Manage a defined book of insurance payers and serve as the subject matter expert for each.
• Meet or exceed monthly productivity and resolution objectives, and KPIs centered around collection percentage goals.
• Conduct timely follow-up on outstanding claims, ensuring resolution and reimbursement within established payer timelines.
• Review, analyze, and appeal denied or underpaid claims in accordance with payer policies and contractual obligations.
• Identify trends in denials and underpayments and escalate issues to management.
• Communicate with insurance companies via phone, payer portals, or written correspondence to resolve claim issues.
• Ensure all claim activity is accurately documented within the billing system for audit and tracking purposes.
• Monitor payer-specific timely filing limits and authorization processes to ensure compliance.
• Prepare and submit corrected claims or claim reconsiderations as needed.
• Stay updated on payer guidelines, filing terms, authorization workflows, and general rules.
• Limited phone work exclusively dealing with care managers; minimal to no direct interaction with patients or consumers.

Requirements

• Experience with health insurance claims.
• Strong analytical and problem-solving skills.
• Ability to communicate effectively with insurance companies.
• Knowledge of payer guidelines and compliance requirements.
• Attention to detail in documenting claim activity.
• Ability to work independently and manage time effectively.
• Familiarity with billing systems.
• Residency in one of the specified states.

Benefits

• Full-time remote position.
• Competitive hourly rate.
• Opportunity to work in a growing industry.
• Supportive team environment.