Billing Representative

This is a fully remote position, open to applicants in United States.

📋 Description

• Conducts daily billing activities for Hospital (HB) and/or Medical Group (PB) claims, which includes the generation and transmission of claims.

• Oversees primary, secondary, and tertiary billing, addressing claim edits and rejections, while ensuring claims are submitted in accordance with payer guidelines.

• Functions as a member of the Billing team to guarantee timely, accurate, and compliant billing operations.

• Recognizes routine billing challenges and resolves or escalates them as necessary.

• Maintains a thorough understanding of state and federal laws relating to insurance contracts and payer billing timelines.

• Investigates and manages overpayment and underpayment accounts to maximize reimbursement.

• Implements payer rules, contracts, schedules, and relevant data to ensure claims are billed both accurately and promptly.

• Analyzes payer trends and provides insights to enhance billing accuracy and operational efficiency.

• Monitors and reports on denial types and their root causes, suggesting process enhancements.

• Evaluates, categorizes, and resolves claim rejections from commercial, government, and managed care payers.

• Records all actions and follow-up procedures in the patient accounting system.

• Addresses patient and payer inquiries or appropriately refers them to the relevant parties.

• Compiles and submits reports that document billing trends, outcomes, and claim activity.

• Analyzes data, draws conclusions, and reviews findings with the supervisor.

• Engages in cross-training across various functions to improve service delivery.

• Keeps updated on applicable federal, state, and local laws and regulations.

• Performs additional duties as assigned.

⛳️ Requirements

• High school diploma or Associate degree in Accounting, Business Administration, or a related field.

• A minimum of two (2) to three (3) years of experience in revenue cycle medical billing, insurance follow-up, and denial management in one of the following environments: Hospital or clinic, health insurance company or managed care organization, healthcare financial services setting.

• An equivalent combination of education and experience may be accepted.

• Experience in a complex, multi-site healthcare system is preferred.

• Exceptional written and verbal communication abilities.

• Strong organizational and time-management skills with a keen attention to detail and accuracy.

• Excellent interpersonal and customer service capabilities.

• Basic proficiency in Microsoft Office (Outlook, Word, PowerPoint, Excel).

• Completion of regulatory and mandatory certifications is preferred.

• Comfortable working in a collaborative, shared-leadership environment.

• Prior experience with Global Partner vendors is preferred.

• Familiarity with the Epic system.

• Knowledge of CPT, ICD-10, and HCPCS coding.

• Strong problem-solving abilities.

• Capability to work independently, meet deadlines, and maintain high attention to detail.

• Certification as a Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or an equivalent certification is preferred.

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Flexible work hours.

• Paid time off.

• Remote work options.