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Job Description – RCM Insurance Specialist

Summary of the Role:

Reports to – Michele Hernandez

Location – Coral Springs, FL or West Plains, MO

Hours – 8:00a - 4:30p M-F, Full time, In Office

Overview of the Role

Quest Health Solutions is seeking a detail-oriented and process-driven Insurance Systems & Configuration Specialist to support our Revenue Cycle and Resupply operations. This role is responsible for maintaining payer and insurance configuration accuracy within Brightree and related systems, ensuring clean claim flow, reducing billing issues, and supporting operational efficiency across teams.

Essential Duties and Responsibilities

• Perform quality assurance reviews on insurance configurations and payer setups
• Manage payer setup, maintenance, and configuration updates within Brightree
• Configure, validate, and troubleshoot electronic claim (E-claim) setups
• Review and correct payer addresses and insurance routing information
• Identify and correct payer or insurance setup issues that could impact claims processing
• Audit reorder insurance verifications for accuracy and completeness
• Work and resolve Incomplete Demographic WIPs, including:
• Missing policy numbers
• Insurance policy changes or updates
• Incomplete or invalid insurance information
• Demographic discrepancies impacting order processing or billing

What You’ll Bring

• DME & Insurance Operations Experience: Previous experience in healthcare revenue cycle management, DME, medical billing, insurance verification, or payer configuration. Strong understanding of payer structures, insurance workflows, and claim processing requirements.
• Brightree & System Configuration Knowledge: Familiarity with Brightree, payer setup and maintenance, E-claim configuration, insurance validation workflows, and revenue cycle operations. Experience troubleshooting payer or configuration issues preferred.
• Insurance Verification & Demographic Review Skills: Ability to review and resolve incomplete demographic and insurance-related WIPs, including missing policy numbers, insurance changes, invalid coverage information, and demographic discrepancies impacting billing or order processing.
• Quality Assurance & Analytical Thinking: Strong attention to detail with the ability to audit insurance verifications, review payer configurations for accuracy, identify trends, and proactively resolve issues before they impact claims or operations.
• Problem-Solving Ability: Demonstrated ability to research, analyze, and resolve complex insurance, payer, or claim routing issues efficiently while identifying root causes and process improvement opportunities.
• Communication Skills: Strong verbal and written communication skills with the ability to collaborate effectively with internal teams and insurance providers to obtain and validate accurate information.
• Organizational Skills: Excellent organizational and time management skills with the ability to manage multiple priorities, maintain accuracy in a fast-paced environment, and ensure timely follow-up and resolution of outstanding issues.

Why Quest Health Solutions

At Quest Health Solutions we are not just a company; we are a community committed to providing unparalleled service to our patients and their families. Our mission is rooted in compassion, excellence, and a drive to innovate in healthcare. We believe in creating a work environment that fosters growth, supports ambition, and values every individual's contribution.

We recognize our people drive everything we accomplish, and as such, we are dedicated to investing in our employees by fostering a culture of continuous learning, growth, and excellence.

Our team works hard, and we recognize the importance of taking care of ourselves. We offer a comprehensive suite of benefit offerings to support the health, well-being, and financial health of our employees and their families. Our robust benefits package underscores our commitment to our people, our most important asset.

Quest Health Solutions seeks excellence through diversity in its staff. We prohibit discrimination based on race, color, religion, sex, age, national origin, sexual orientation, gender identity or expression, disability, veteran status, or marital status.