Mercor connects elite creative and technical talent with leading AI research labs. This role oversees medical billing and claims submission operations, evaluates AI-generated billing outputs for accuracy and payer compliance, manages billing workflows, and supports AI training datasets through structured feedback.
Key responsibilities include:
- Oversee end-to-end medical billing and claims submission operations across professional fee and/or facility billing environments.
- Evaluate AI-generated billing outputs, claim edits, and coding validations for accuracy and payer compliance.
- Manage claims submission workflows including electronic claim generation, clearinghouse edits, and payer-specific billing requirements.
- Monitor clean claim rates, rejection rates, and first-pass acceptance rates, and develop improvement strategies.
- Coordinate with coding, CDI, and collections teams to resolve billing edits and claim rejections.
- Ensure compliance with CMS billing guidelines, HIPAA 837 transaction standards, and payer-specific billing rules.
- Annotate AI outputs and provide structured feedback to support AI training datasets.
Requirements & Qualifications
- 5+ years of experience in medical billing and claims management, including at least 2 years in a management role.
- Deep knowledge of professional fee (CMS-1500/837P) and/or facility (UB-04/837I) billing requirements.
- Expertise in HIPAA 837 transaction standards, clearinghouse operations, and payer-specific billing rules.
- Strong understanding of Medicare, Medicaid, and commercial payer billing requirements.
- Proficiency with billing platforms such as Epic, Athenahealth, AdvancedMD, or equivalent, plus clearinghouse tools.
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to identify billing errors and compliance issues in AI-generated outputs.
- Preferred: CPC, CCS, CHFP, or CRCR certification.
- Preferred: Experience with automated billing platforms and RCM technology implementations.
- Preferred: Background in multi-specialty physician group, hospital, or health system billing operations.
- Preferred: Familiarity with AI tools and comfort evaluating AI-generated billing content.
- Preferred: Experience with payer contract interpretation and billing compliance program management.
Location
N/A
Employment Type
Contractor
Experience Level
Manager
Remote work allowed
Yes
Posted
1 month ago
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