Medical Billing and Revenue Cycle Specialist

HUDSON PHYSICIANS SC•Hudson, WI

2d•Hybrid

About The Position

As a Medical Billing & Revenue Cycle Specialist, you will be responsible for insurance claim follow-up, denial resolution, and accounts receivable management. This position plays an important role in revenue generation, timely reimbursement, and maintaining a clean accounts receivable. You will work closely with insurance payers, patients, and internal teams to research and resolve outstanding claims and ensure accurate payment. The position will be primarily staffed remotely during business office hours. All training is completed remotely.

Requirements

Minimum: High School Diploma or equivalent
Minimum: 1-2 years in Healthcare Business Office.
Experience working insurance denials and appeals.
Understanding of EOBs/ERAs and insurance reimbursement.
Knowledge of medical terminology and health insurance.
Proficient with ICD-10 and CMS billing guidelines.

Nice To Haves

Desired: Post-secondary education.
Desired: 2-4 years Insurance Billing, denials and follow up.

Responsibilities

Work assigned accounts, claims, and aging work queues to ensure timely follow-up and resolution.
Research unpaid, underpaid, and denied claims to determine the reason for non-payment and the appropriate next step.
Communicate with insurance companies through payer portals, phone calls, and written correspondence.
Submit corrected claims, reconsiderations, and appeals based on payer requirements.
Review accounts for accurate insurance information, claim filing, payments, adjustments, denials, refunds, and credit balances.
Review electronic claim status information and take appropriate action.
Respond to patient questions related to insurance claims and billing in a professional and compassionate manner.
Partner with coding and other Revenue Cycle team members when additional review or clarification is needed.
Identify patterns and trends in denials and claim processing and communicate opportunities for improvement to the team.
Stay current on payer policies and changes that may impact billing and reimbursement.
Maintain accurate documentation and records for assigned accounts.
Manage multiple priorities while meeting daily, weekly, and monthly deadlines.
Maintain confidentiality.
Establish and maintain positive working relationships.
Work independently with minimal instruction in team environment.
Attend training sessions, in-services, departmental and facility meetings.
Adheres to the philosophy and provides comprehensive care according to a patient centered healthcare clinic.
Perform other duties and responsibilities as required or assigned by the Revenue Cycle leadership.
Ability to multi-task and meet daily, weekly and monthly deadlines.