Sr Insurance Specialist

Role Summary: 

The Senior Insurance Representative—coding and denials (Hospital Billing)—is responsible for expert-level denial management and resolution within the hospital billing environment. This role requires advanced knowledge of medical coding (ICD-10-CM, CPT, HCPCS), hospital billing practices, and payer regulations. The representative will analyze, appeal, and resolve coding-related denials, working collaboratively with internal teams and payers. This is a remote position.

Essential Duties and Accountabilities: 

• Managed and resolved coding-related denials for hospital claims, significantly contributing to the reduction of outstanding accounts receivable.
• Demonstrate advanced proficiency in medical coding (ICD-10-CM, CPT, HCPCS) and apply this knowledge to effectively appeal denied claims.
• Thoroughly analyze reasons for denial and identify root causes, including coding errors, documentation deficiencies, and payer-specific requirements.
• Prepare and submit well-documented appeals to payers, ensuring compliance with all applicable regulations and guidelines.
• Maintain up-to-date knowledge of payer policies, coding guidelines, and industry best practices.
• Collaborate with internal teams (e.g., billing, coding, clinical documentation improvement) to address denial trends and implement process improvements.
• Maintain accurate records of denial activity and resolution outcomes.
• Meet or exceed established performance metrics related to denial resolution and recovery rates.
• Represent the company professionally in all communications with payers, clients, and internal stakeholders.
• Contribute to team knowledge sharing by providing training and support to other team members on coding and denial management.

Education/Experience/Minimum Qualifications: 

• A high school diploma or GED is required; an associate or bachelor’s degree in healthcare administration, health information management, medical billing and coding or a related field is preferred.
• Minimum of 3-5 years of experience in medical billing and denial management, strongly focusing on coding-related denials within a hospital setting.
• Demonstrable expertise in ICD-10-CM, CPT, and HCPCS coding.
• Solid understanding of hospital billing processes (UB-04 claim form).
• Experience working with various payer types (Medicare, Medicaid, commercial insurance).
• Active coding certification (CPC, CCS, RHIT, RHIA) from an accredited organization is strongly preferred but not required.
• Proficiency with relevant software and systems (e.g., billing systems, clearinghouses, payer portals).

Competencies: 

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions:

• Exceptional analytical and problem-solving skills.
• Excellent written and verbal communication skills.
• Strong attention to detail and accuracy.  
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).  
• Knowledge of HIPAA regulations and compliance.

Special Position Requirements:

Language Skills: Ability to read, analyze, and interpret information including training instructions and patient bills.

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. 

Reasoning Ability: The person in this position frequently communicates with consumers who have inquiries about their bills. Must be able to exchange accurate information in these situations.

Computer Skills: Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.

Work Environment: Must have a dedicated, quiet workspace for remote work.

Connectivity: Reliable high-speed internet access.

Work Requirements: 

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to remain in a stationary position over 50% of the time. Constantly works in indoor weather conditions.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  The noise level in the work environment is usually quiet.

Meduit is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, religion, sex, age, national origin, disability, military status, genetic information, sexual orientation, marital status, domestic violence victim status or status as a protected veteran or any other federal, state or local protected class.