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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing the insurance claims process, including resolving claim denials and optimizing revenue cycle management. Proficient in medical billing software and electronic health records, with a strong understanding of billing regulations and healthcare procedures.
Highest-signal resume keywords
Insurance/AR Follow-Up ExperienceMedical Billing Software ProficiencyClaim Denial ResolutionCertified Professional Biller (CPB)Understanding of Medical Terms and Healthcare Procedures
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance Claims ManagementBilling AccuracyRevenue Cycle ManagementElectronic Medical Records (EMR)Claim SubmissionCoding Changes RecommendationSoft CollectionsDenial Report ReviewEligibility VerificationSecondary Claims Submission
Soft Skills
Effective Communication SkillsAbility to Work IndependentlyTask ManagementProblem Solving
Tools & Technologies
KareoAdvancedMDElectronic Health Records (EHR)
Certifications & Qualifications
Certified Professional Biller (CPB)Certified Coding Specialist (CCS)
Industry Keywords
Healthcare ProceduresInsurance DenialsAccounts ReceivableBilling RegulationsLocal Healthcare Landscape
About the role
Key responsibilities & impact- Manage the insurance claims process and follow up on outstanding accounts receivable
- Identify and resolve claim denials
- Appeal underpaid or rejected claims
- Communicate with insurance companies and patients to facilitate timely reimbursement
- Utilize insurance billing procedures, coding, and reimbursement regulations to optimize revenue cycle management and minimize revenue loss
- Use electronic medical records (EMR)
- Post charges for services in a timely manner
- Submit clean claims electronically to carriers
- Review and maintain clearinghouse reports
- Verify eligibility and benefit coverage
- Investigate and review insurance denials and update accounts
- Prepare and submit secondary claims as needed
- Resolve questions related to deductibles, co-insurance, and co-pays
- Prepare and submit appeal letters to insurance carriers
- Recommend coding changes as required
- Perform soft collections as needed
- Scrub Aged Trial Balance Reports for insurance discoveries
- Train required team members as needed
- Review denial reports, update accounts, and resolve denials
- Generate bad debt submission reports and PFC Medicaid eligible reports
- Assist with internal auditing initiatives
- Perform other duties assigned by the management team
Requirements
What you’ll need- Insurance/AR follow-up experience required
- Accuracy in billing is crucial to avoid errors and ensure proper reimbursement
- Ability to work independently
- Proficiency in medical billing software (e.g., Kareo, AdvancedMD) and electronic health records (EHR) systems preferred
- Understanding of medical terms, anatomy, and healthcare procedures
- Effective verbal and written communication skills for interacting with colleagues, patients, and insurance companies
- Ability to resolve billing discrepancies and manage claim denials
- Efficient in managing multiple tasks and meeting deadlines
- At least two years of experience in AR, medical billing or a related industry
- High School Diploma/GED is required
- An associate’s degree in medical billing, health information management, or a related field can be advantageous
- Certification as a Certified Professional Biller (CPB) or Certified Coding Specialist (CCS) is preferred
- Relevant certifications can be obtained from organizations like the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA)
- Ongoing education to stay current with changes in billing codes and regulations
- Understanding of the local healthcare landscape, including major insurers and healthcare providers is preferred
Benefits
Comp & perks- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Paid training
- Tuition reimbursement
- Vision insurance