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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complex medical claims and appeals processes, ensuring compliance with payer regulations and maximizing reimbursement. Proficient in analyzing payment discrepancies and implementing corrective actions while achieving productivity and quality benchmarks.
Highest-signal resume keywords
CRCR CertificationICD-10 KnowledgeCPT/HCPCS KnowledgeEHR/EMR Systems ExperienceMedical Claims Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Claims SubmissionDenial ResolutionPayment Discrepancy AnalysisReimbursement MaximizationAccount AdjustmentsClaims VerificationError CorrectionPayer Policy KnowledgeHealthcare Revenue Cycle AdministrationNegotiation Skills
Soft Skills
Problem-Solving AbilitiesResearch SkillsAttention to DetailCommunication SkillsCollaboration Skills
Tools & Technologies
Microsoft Office SuiteTeamsMeditechEpicCernerAllscriptsNextgen
Certifications & Qualifications
CRCR Certification
Industry Keywords
Healthcare Revenue CyclePayer GuidelinesEOB ReviewInsurance Accounts ReceivablesClaim Denials
About the role
Key responsibilities & impact- Independently manage high-dollar, high-volume, and complex accounts with significant financial impact
- Submit accurate medical claims in compliance with federal, state, and payer-specific requirements
- Resolve multi-level denials through advanced research, payer escalation, and detailed follow-up
- Investigate and follow up with payers to collect insurance accounts receivables
- Prepare and submit first- and second-level appeals with complete supporting documentation, tracking and following up to maximize reimbursement
- Execute and oversee EHR workflows, including reroutes, denial closures, and account adjustments
- Review EOBs to resolve payment discrepancies, claim denials, and contractual underpayments
- Complete rebills and corrections to maximize reimbursement
- Analyze payment discrepancies and take corrective actions
- Meet productivity and quality benchmarks
- Research, analyze, and correct errors and rejections; identify root causes and implement preventive solutions
- Verify and adjust claims to ensure accurate client liability and account balance
- Stay informed about payer guideline and process changes
- Identify payer trends impacting reimbursement and bring findings to management
- Participate in daily shift briefings
- Achieve 125% of the project daily productivity goal and a 95% monthly quality assurance score
Requirements
What you’ll need- High school diploma or equivalent required
- Associate's degree preferred
- CRCR certification or completion of certification required within 90 days of hire
- Minimum 3 years of experience in securing medical claim payments, managing follow-up, and appealing denials, with proven success resolving complex, high-value claims
- Advanced knowledge of ICD-10, CPT/HCPCS, payer policies, and reimbursement regulations
- Strong negotiation, research, and problem-solving abilities
- Experience using EHR/EMR systems such as Meditech, Epic, Cerner, Allscripts, Nextgen, or similar platforms
- Proficiency in Microsoft Office Suite, Teams, and various desktop applications
- Knowledge of ICD-10 diagnosis and procedure codes and CPT/HCPCS codes
- Knowledge of rules and regulations relative to Healthcare Revenue Cycle administration
- Ability to validate payments, make decisions, learn and use collaboration tools and messaging systems, and research healthcare revenue cycle rules and regulations
- Criminal background check, employment verification check, and government exclusion check required as conditions of employment or engagement