Insurance Reimbursement Specialist

Description

***IMPORTANT NOTICE - Training & Remote Transition: This is a remote position; however, employees will be required to work on-site at Ascent Emergency Medical Center for a training and evaluation period of approximately 90 days before transitioning to remote work. This period may be shortened based on performance and demonstrated proficiency in the role. 

The Insurance Reimbursement Specialist position requires expertise in medical claims entry, processing, and insurance dispute resolution across multiple levels, including IDR (Independent Dispute Resolution), NSA (No Surprises Act), TDI (Texas Department of Insurance), and DOL (Department of Labor).

The ideal candidate is detail-oriented, highly organized, and experienced in handling complex billing tasks, claim disputes, and appeals. This role requires multi-tasking in a fast-paced environment while maintaining accuracy and efficiency.

Responsibilities:

Claims Entry & Processing

• Accurately enter, submit, and process medical claims through CMD (billing software)
• Review and correct claim errors before submission
• Ensure compliance with payer guidelines and state/federal regulations

Disputes, Appeals, & Insurance Processing

• Manage NSA/IDR dispute submissions and follow-ups
• Handle insurance disputes at all levels (TDI, DOL, IDR, and direct carrier appeals)
• File and track provider and member appeals for denied or underpaid claims
• Investigate claim denials and resolve outstanding balances

Insurance & Payment Processing

• Post insurance payments, adjustments, and denials via ERA (Electronic Remittance Advice)
• Navigate insurance portals to track claim status, retrieve EOBs, and process reconsiderations
• Call insurance companies for claim status, appeals, adjustments, and dispute resolutions

Administrative & Multi-Tasking

• Maintain detailed documentation of claim activity in CMD
• Work with team members to meet deadlines and ensure claims are worked efficiently
• Manage multiple claims and appeals simultaneously while staying organized
• Assist with refund requests, coordination of benefits (COB), and other billing-related tasks

Requirements

Qualifications:

• Experience in medical claims billing, processing, and dispute resolution
• Strong knowledge of NSA/IDR, TDI, DOL, and insurance dispute processes
• Familiarity with ERA, insurance portals, and electronic claim submission
• Experience with billing software (CMD preferred)
• Ability to multi-task, prioritize, and manage high claim volumes
• Strong communication and problem-solving skills
• Knowledge of insurance guidelines, coding, and reimbursement policies
• Previous experience with appeals, insurance follow-ups, and claim adjustments