Medical Billing Specialist

Job Description

Job Description

Position Overview

We are looking for a detail-oriented and experienced Patient Account Representative II to join our team. If you have a strong understanding of Revenue Cycle Management processes, especially in handling denials and appeals, we would love to hear from you.

Key Responsibilities
Analyze denials and determine the best course of action for appeal or resubmission.
Prepare and submit accurate and compliant appeals for denied claims.
Collaborate with billing, coding, and clinical staff to gather necessary information for appeals and resolve denial issues efficiently.
Maintain detailed records of denial cases, including appeals filed and communications with insurance representatives.
Monitor the status of appealed claims and follow up with insurance representatives to expedite resolution.
Generate and analyze reports on denial trends, identify root causes, and recommend process improvements.

Qualifications
Required Education, Licensure, Certifications, & Experience:
High school diploma or equivalent.
2 years of current experience in claims processing and denials management.
1 year of current experience with EPIC.
Recent experience working with the EPIC EMR system.

Required Skills
Ability to analyze denial reasons, identify trends, and develop strategies to minimize denials.
Excellent written and verbal communication skills for effective communication with internal staff and insurance representatives.
Strong attention to detail and accuracy in documentation and appeals submissions.
Ability to collaborate effectively with multidisciplinary teams to achieve common goals.
Thorough understanding of billing regulations, coverage guidelines, and the appeals process.

Physical Requirements
Sitting: 90%
Standing/Walking: 10%
Occasional lifting/carrying of supplies and paper weighing up to 40 pounds.
Occasional pushing/pulling to move supplies and equipment.
Occasional climbing of stairs to reach other levels of the building.
Occasional stooping/kneeling/bending/crouching to file in low cabinets, purge old bills, and print forms.
Occasional reaching/handling/fingering to complete paperwork, use computers, file, and answer telephones.
Frequent talking/hearing/seeing to interact with staff and customers to complete assigned tasks.

Environmental Conditions
Inside
Location: Onsite or Remote