Medical Billing & Claims Management:
- Prepare, review, and submit accurate medical claims to insurance companies (private, Medicare, Medicaid) using ICD-10, CPT, and HCPCS codes.
- Verify patient insurance coverage, eligibility, and benefits to ensure accurate billing and prevent claim denials.
- Monitor submitted claims, track statuses, and follow up on unpaid, denied, or rejected claims to ensure timely reimbursement.
- Identify reasons for claim denials, correct errors, gather missing documentation, and resubmit claims as needed.
- Accurately post payments, adjustments, and rejections to patient accounts while maintaining clean financial records.
- Ensure all billing activities comply with U.S. healthcare regulations, including HIPAA, payer-specific guidelines, and coding standards.
- Generate billing, collection, and claims-tracking reports to help improve revenue cycle efficiency.
Qualifications:
- Minimum of four (4) years of proven experience in U.S. Medical Billing, Claims Processing, or Revenue Cycle Management.
- Strong understanding of medical terminology, common diagnoses, procedures, and treatment workflows (no clinical background required).
- Proven experience in U.S. medical billing, claims processing, or revenue cycle management.
- Must be proficient with ICD-10, CPT, and HCPCS coding and familiar with HIPAA regulations.
- Hands-on experience using medical billing software, EMR/EHR systems, and insurance portals.
- High attention to detail with the ability to identify coding errors, documentation gaps, and inconsistencies in claims.
- Ability to research, analyze, and resolve denied or unpaid claims and handle follow-ups with insurers.
- Organized, analytical, and able to manage high volumes of data efficiently.
- Professional and confident communicating with insurance representatives, healthcare providers, and internal teams.
- Excellent written and verbal English communication skills, especially in explaining billing issues and coordinating claim resolutions.
