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.
This is a full-time, remote position requiring a daily schedule of 9:00am-5:00pm EST.
Permanent residency in one of the following states is required: PA, DE, GA, MI, NC, TX, NJ, and FL only.
Hourly rate: $22/hour
Key Duties and Responsibilities:
- 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.
- Must be legally authorized to work in the United States without the need for employer sponsorship now or in the future.
- Proficiency in the Microsoft Office suite of applications required.
- Strong analytical skills.
- Strong communication with excellent oral and written communication skills.
- Critical thinking - ability to decipher when things are missing or incorrect.
- Accurate and organized with the ability to multitask.
- Friendly phone demeanor - will be in direct contact with care managers.
- Self-starter who can work in a remote environment. Must be able to work both independently and collaboratively on a small team and be accustomed to working with deadlines.
- Punctual and reliable with a professional appearance and demeanor.
Desired Experience:
- High school diploma or equivalent required; associate or bachelor’s degree preferred.
- 2+ years of experience in medical billing or revenue cycle management, with emphasis on insurance follow-up or A/R.
- Experience with Medicaid and Managed Care Organization a plus.
- Strong understanding of claim lifecycles, payer policies, and denial management.
- Familiarity Salesforce and/or Waystar is a plus.
- Ability to work independently and manage time effectively within a high-volume environment.
- Health Care Plan (Medical, Dental & Vision)
- Paid Time Off (Vacation & Public Holidays)
- Short Term & Long Term Disability
- Retirement Plan (401k)
