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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive experience in healthcare insurance billing, follow-up, and collections, with a strong understanding of Medicaid processes and compliance with regulatory guidelines such as HIPAA. Proficient in managing complex insurance denials and underpayments while maintaining high productivity and quality standards.
Highest-signal resume keywords
Healthcare Insurance BillingMedicaid ProcessesInsurance Denial ManagementRubixis AR Follow Up SoftwareMedical Coding Certification
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 BillingReimbursement ProcessesContract AnalysisCPT CodesICD CodesUB-04 Follow-UpEOB/RA InterpretationMathematical FunctionsPayer Contract LanguageHealthcare Revenue Cycle
Soft Skills
Problem-SolvingOrganizational AbilityWritten CommunicationVerbal CommunicationMentoring
Tools & Technologies
EPICParagonZirmedMS Office WordMS Office ExcelPatient Accounting SystemsEMR Systems
Certifications & Qualifications
Medical Coding CertificationBilling Certification
Industry Keywords
HIPAA ComplianceFCRA ComplianceGLBA ComplianceHealthcare InsuranceClinical Setting
About the role
Key responsibilities & impact- Learn and understand the ARO platform and available resources
- Manage assigned accounts from start to finish in a timely manner
- Call healthcare insurance companies, affiliates, and providers to resolve contract or payment issues
- Analyze contract, billing, cash costing, pricing, and collections in compliance with regulations, policies, and procedures
- Investigate insurance payments that deviate from expected payment
- Collaborate with leadership and team members to confirm, challenge, or provide trends and solutions
- Document research outcomes and work performed on accounts or subaccounts
- Use system status codes, follow-up, and mark-ahead responses accurately
- Escalate items to senior staff or management when appropriate
- Validate bulk underpayment or denial trends
- Follow up on mid-dollar balances according to project criteria
- Create appeals and patient or payer correspondence
- Maintain compliance with regulatory guidelines, including HIPAA
- Mentor Rep I associates
- Manage moderately complicated insurance denials and underpayments using Rubixis AR Follow Up software
Requirements
What you’ll need- 5+ years of experience with healthcare insurance billing, follow-up, and collection in a hospital, clinical, or BPO vendor environment
- Proven track record of success in reimbursement and follow-up
- Knowledge of Medicaid payer rules and processes, including interpreting denial reasons, submitting appeals to Medicaid payers, and accessing Medicaid portals
- Basic understanding of HIT systems such as EPIC, Paragon, Zirmed, or other billing systems
- Ability to resolve higher-complexity denials and underpayments
- Ability to understand and use payer contract language in calls with payers
- Basic understanding of the healthcare revenue cycle in a hospital or clinical setting
- Intermediate to advanced understanding of insurance billing, reimbursement, and follow-up processes
- Familiarity with different payer types for claims processing and adjudication
- Ability to use medical billing terminology, including UB/1500 claim types, CPT, ICD, DRG codes, and EOB/RA
- Proficient understanding and interpretation of payer correspondence
- Excellent written and verbal communication
- Proficiency with basic mathematical functions
- Problem-solving and organizational ability
- Able to consistently maintain or exceed minimum average daily productivity and quality after 90 days
- Understanding of Patient Accounting systems/EMR
- Skills with MS Office Word and Excel applications
- Degree in a related field
- Certification in billing or medical coding
- 5+ years of experience in UB-04 follow-up and/or contract/reimbursement analysis, including pricing and reimbursement variance investigations
- 5+ years of experience with Medicaid processes and systems
- Compliance with HIPAA, FCRA, GLBA, and other applicable laws
- Commitment to integrity, ethics, confidentiality, and FinThrive’s core values
Benefits
Comp & perks- FinThrive perks and benefits are referenced, with current offerings available at finthrive.com/careers-benefits
- Equal Opportunity Employer
- Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions
- Self-development and continuous feedback and learning opportunities
- Required compliance training