Job Description

• Identifies opportunities that enhance operational efficiency and improve overall results

• Assists with held revenue by obtaining, reviewing, and validating required documentation to support claim resolution
• Communicates with customers, payers, and internal teams to gather information, clarify requirements, and resolve outstanding issues
• Applies knowledge of payer medical policies, coverage criteria, and reimbursement guidelines to ensure accurate claim processing
• Follows established standard operating procedures to maintain compliance, consistency, and quality in all workflows
• Monitors accounts for delays, missing documentation, or policy-related barriers and takes proactive steps to resolve them
• Identifies trends, gaps, or recurring issues that impact revenue flow and escalates or recommends solutions as appropriate
• Collaborates with team members to streamline processes, enhances operational efficiency, and improve overall performance results
• Maintains accurate records, notes, and documentation within company systems to support audit readiness and transparency
• Meets productivity, quality, and turnaround time expectations as defined by departmental standards
• Participates in training, policy updates, and continuous improvement initiatives to stay current with payer requirements and internal processes

• High School Diploma or General Education Degree (GED), Required

• 1 year or more in held revenue, accounts receivable, medical billing, or related healthcare reimbursement functions, preferred
• healthcare industry, durable medical equipment (DME), or insurance verification is a plus

• payer requirements, medical policies, and coverage guidelines, preferred
• Proficiency with Microsoft Excel and Word, including data entry, documentation management, and basic reporting
• Strong attention to detail to analyze account information and identify discrepancies
• Effective written and verbal communication for interacting with customers, payers, and internal teams
• manage multiple tasks, prioritize workload, and meet productivity and quality expectations
• Comfortable working in a fast paced, process driven environment with evolving payer requirements
• This position requires use of your own equipment
  • Internet Service Type: Cable or Broadband
  • Network Firewall on the Internet Connection
  • Connection Type: Wired to ISP Modem
  • Latency to Florida or Tennessee Data Centers / Ping: < 30ms
  • Download Speed: Minimum 80 Mbps
  • Upload Speed: Minimum 10 Mbps
  • Monitor Size: Minimum 20" Dual Monitors
  • Processor Speed: Minimum 1.5 GHz -- Preferred 2.0 GHz
  • Main Memory (RAM): Minimum 8GB
  • Free Disk Space: Minimum 1GB
  • Keyboard: Wired (Wireless not supported)
  • Mouse: Wired (Wireless not supported)
  • Audio: USB Headset (Bluetooth/AUX not supported)
  • Network Connector: Wired Ethernet
  • Webcam
  • OS Version: Windows 11 (Other OS like ChromeOS/Linux/MacOS not supported)
  • OS Update: Automatic
  • Antivirus: Automatic updates, always scan mode
  • Windows Firewall (Enabled)
  • Supported Browsers: Chrome, Edge (Preferred)
  • HIPAA compliant workspace (Room with a door)
  • Functional work surface (Desk) and chair
  • Distraction-free environment