Insurance Billing Professional

Submit and follow up on government and commercial payer claims to secure appropriate reimbursement Prevent denials by validating authorization, eligibility, medical necessity indicators, modifiers, diagnosis/procedure alignment, and required documentation Review claim edits and resolve preventable edits to maximize first-pass acceptance Monitor denial and rejection patterns by payer, plan, and category Conduct root cause analysis and implement prevention actions with Denials Analysts and Leadership Maintain payer requirement grids, reference files, tip sheets, and other denial prevention tools Communicate payer policy changes, recurring denial themes, and emerging risks Bill primary, secondary, and tertiary payers and initiate patient balance billing according to policy and regulations Monitor assigned insurance work queues and resolve encounters, including Charge Error DOS, Adjustments, and Client Bill workqueues Investigate and resolve payer rejections, denials, and underpayments Assist with encounters from other staff members’ work queues to prevent backlogs Maintain timely, complete, and audit-ready account notes and follow-up actions Run, distribute, and review ATB and denial-related reports; identify trends and priority actions Translate reporting into recommendations for training, workflow changes, and escalations Maintain accurate payer reference information Participate in continuous quality improvement initiatives Assist leadership with daily, weekly, and monthly audits of team members and workqueues Support onboarding, training, and coaching for new hires and team members Partner with the Denials Team and Leadership on education and standard work Participate in team goal setting and contribute to a collaborative, high-performing team Complete Leadership-requested projects accurately and on time Continue demonstrating proficiency in Insurance Billing and Follow-up representative/associate responsibilities Requirements High school diploma/GED, or higher education One of the following credentials or equivalent: CPC, CPB, CBCS, COC, CIC, CRCR, HBI, HFMA certificates preferred Maintains credential continuing education (CE) requirements as applicable Strong written and verbal communication skills Proficient computer skills, including EHR/billing systems, claim editing tools, and payer portals Strong attention to detail and data accuracy Strong analytical skills for identifying denial trends, determining root causes, quantifying impact, and recommending corrective actions Strong organizational skills; ability to prioritize aged/at-risk accounts, meet deadlines, and manage high-volume work Critical thinking and sound judgement Ability to develop training materials and provide coaching/training Intermediate to advanced Excel/reporting skills preferred, including filters, pivots, and lookups Experience building or maintaining denial reference tools and supporting standard work preferred Maintains patient confidentiality and complies with HIPAA, payer policies, and applicable regulations Core Competencies Demonstrates expertise in Insurance Billing and Follow-up, with a strong focus on denial prevention, root cause analysis, and effective communication of payer policies. Proficient in utilizing EHR/billing systems and advanced Excel skills to analyze data and support continuous quality improvement initiatives. Highest-signal resume keywords Insurance Billing Denial Prevention Root Cause Analysis EHR/Billing Systems Excel Reporting Skills ATS Optimization Keywords Hard Skills Claim Editing Tools Payer Portals Data Analysis Medical Necessity Validation Authorization Verification Denial Trend Identification Patient Balance Billing Documentation Accuracy Payer Requirement Maintenance Audit-Ready Account Notes Soft Skills Strong Communication Skills Attention to Detail Organizational Skills Critical Thinking Coaching and Training Ability Certifications & Qualifications CPC CPB CBCS COC CIC CRCR HBI HFMA Certificates Industry Keywords HIPAA Compliance Payer Policies Denial Management Quality Improvement Healthcare Billing #J-18808-Ljbffr Jobtailor