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This Surgery Medical Biller/Collections Specialist involves managing claim submissions, addressing denials, and ensuring the accuracy of billing processes to optimize reimbursement.
Job Responsibility:
Address and correct front-end edits and clearinghouse errors to facilitate clean claim processing
AR Insurance follow up via phone and online web portals
Submit electronic claims in compliance with specific payer guidelines and requirements
Manage timely corrections, rebills, and resubmissions of claims to resolve outstanding issues
Handle claim attachments and supporting documentation to meet payer requirements
Investigate and resolve denials by preparing appeals with appropriate clinical, coding, and billing documentation
Coordinate outreach to payers for unresolved or aged claims and follow up on outstanding accounts
Collaborate with patient access and coding teams to address discrepancies and ensure billing accuracy
Monitor payer trends, escalate systemic issues, and recommend improvements to prevent recurring denials
Verify patient information, including demographics, insurance coverage, and authorization details, to ensure claims are accurate before submission
Assist leadership with high-dollar or time-sensitive accounts to ensure timely resolution
Requirements:
Minimum of 3–5 years of experience in healthcare billing, claims follow-up, and denial management
At least 2 years of hands-on experience with Epic billing workflows and denial resolution processes
Comprehensive understanding of payer guidelines, claim submission protocols, and appeal procedures
Strong attention to detail and the ability to accurately manage complex billing tasks
Proven organizational skills with the ability to prioritize multiple responsibilities
Expertise in medical billing, collections, denials, appeals, and ambulatory surgery
Familiarity with compliance standards and regulations governing medical records
Ability to collaborate effectively with multiple teams to achieve billing accuracy and reimbursement goals
What we offer:
medical, vision, dental, and life and disability insurance