Responsible for identifying, investigating, appealing, and resolving denied or rejected insurance claims to maximize reimbursement and reduce accounts receivable. Works closely with providers, coding, billing, and payer representatives to resolve claim issues, identify denial trends, and improve revenue cycle performance while ensuring compliance with payer guidelines.
Requirements & Qualifications
Qualifications
- High school diploma required
- Minimum of 2 years of experience in medical billing, collections, denial management, or claims resolution
- Experience with insurance appeals, denial management, and payer follow-up required
- Knowledge of Medicare, Medicaid, and commercial insurance billing guidelines
- Bilingual English/Spanish preferred
- Must be able to read, write, and speak English
- Basic computer knowledge including Microsoft Word, Excel, EHR systems, billing software, payer portals, email, and e-fax systems
Certifications
- CPC preferred
Skills and Knowledge
- In-depth knowledge of CPT, ICD-10, HCPCS, CMS-1500 claim forms, medical terminology, and payer billing requirements
- Strong understanding of denial management, claims resolution, reimbursement methodologies, and insurance appeals
- Knowledge of Medicare, Medicaid, and commercial payer policies
- Excellent analytical, problem-solving, organizational, written, and verbal communication skills
- Ability to work independently with minimal supervision
- Ability to maintain patient confidentiality and comply with HIPAA regulations
- Dependable, detail-oriented, and able to follow company policies and procedures
Benefits & Perks
- 100% employer-paid employee health insurance
- Dental insurance
- Vision insurance
- Life insurance
- 401(k) retirement plan
- Paid time off (PTO)
- Paid holidays
Location
Florida, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago