Remote Medical Biller

Job Overview

We invite applications for the position of Medical Biller, a remote role that is integral to our team's success in ensuring efficient processing of insurance claims. This position is pivotal in preparing, reviewing, amending, and updating claims to guarantee timely submissions to payers, emphasizing our commitment to precision in billing and exemplary patient care.

Key Responsibilities

• Investigate and effectively resolve claim denials.
• Identify patterns in denials and manage the resubmission process for various claims.
• Validate denial codes and reasons through comprehensive reviews of Explanation of Benefits (EOB) to guarantee accurate coding of billed procedures.
• Analyze coding adjustments made on EOBs for correctness and necessary support.
• Review Summary Plan Descriptions and related insurance materials to ascertain benefits.
• Formulate and execute strategies for denial resolution and appeal processing.
• Ensure that all appeals are submitted promptly, adhering to Federal, State, and plan guidelines.
• Generate detailed appeals based on specific dispute reasons.
• Document all actions taken during the appeal process, ensuring follow-ups are noted.
• Request and procure relevant medical records, notes, and claims copies as needed.
• Collaborate with third-party payers to resolve appeal claims.
  
  

Required Skills

• Familiarity with Medicaid and Medicare claims denials and the appeals process, including regulatory requirements.
• Understanding of payer medical policies and Medicare Local Coverage Determination (LCD) and National Coverage Determination (NCD) criteria.
• Knowledge of billing and coding criteria.
• Proficiency in Microsoft Office Suite.
• Excellent verbal, written, and interpersonal communication skills, capable of managing multiple demands and responding effectively to time constraints.
• Strong organizational skills along with problem-solving and analytical capabilities.
• Ability to manage time efficiently, maintaining attention to detail and follow-through.
• Well-developed research skills.
• Advanced technical skills to rapidly learn hospital information systems.
• Insight into contracting and credentialing implications on revenue cycle functions.
  
  

Qualifications

• Recent experience in hospital billing is essential.
• Familiarity with charge capture, coding, revenue cycle management, patient accounting, and/or physician billing is advantageous.
• Experience with EPIC EMR is preferred.
• A solid understanding of medical terminology is beneficial.
• A High School Diploma is required.
  
  

Career Growth Opportunities

We believe in nurturing our employees’ potential through continuous professional development. Joining our esteemed organization opens the door to numerous career advancement prospects and mentorship opportunities, allowing you to grow within a supportive network of professionals in the industry.

Employment Type: Full-Time