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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in Hospital Billing and Medicare processes, with a strong focus on resolving insurance claims and managing reimbursement variances. Proficient in using billing systems and analytical tools to ensure compliance and optimize revenue cycle management.
Highest-signal resume keywords
Hospital Billing ExperienceMedicare Processes KnowledgeInsurance Follow-Up ExpertiseAdvanced MS Excel SkillsUB04 Facility Pricing Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Hospital BillingInsurance Follow-UpMedicare Direct Data EntryUB04 Follow-UpContract AnalysisReimbursement AnalysisBilling Regulations ComplianceCash Costing AnalysisPricing AnalysisCollections Management
Soft Skills
Problem SolvingAnalytical SkillsOrganizedDetail-OrientedMentoring
Tools & Technologies
Rubixis AR Follow Up SoftwareEPICParagonZirmed
Certifications & Qualifications
Bachelor's DegreeAssociate Degree
Industry Keywords
Payer TypesMedicare Payer RulesFacility Reimbursement ContractsFee SchedulesRevenue Cycle Management
About the role
Key responsibilities & impact- Learn and understand the Rubixis platform and available resources
- Work assigned accounts from start to finish successfully and 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 on accounts in compliance with billing regulations, policies, and procedures
- Investigate insurance payments that deviate from expected payment
- Work collaboratively with leadership and team members to confirm, challenge, or provide trending and solutions
- Mentor Rep I and Rep II associates
- Manage moderately complicated insurance denials and underpayments using Rubixis AR Follow Up software
Requirements
What you’ll need- 5+ years Hospital Billing with follow up experience
- Advanced knowledge of all payer types
- Knowledge of Medicare payer rules and processes, including interpreting denial reasons, submitting appeals to Medicare payers, and accessing Medicare portals
- Ability to use Medicare Direct Data Entry (DDE) to submit claim corrections, adjustments, and inquiries
- Detailed understanding of insurance follow-up, including resolving non-paid, denied, under-paid, and rejected claims for healthcare providers
- Experience in UB04 Facility Pricing and Reimbursement variance
- Good understanding of revenue cycle
- Basic understanding of HIT systems such as EPIC, Paragon, Zirmed, or other billing systems
- Problem solving / superior analytical skills
- Organized and detail-oriented aptitude
- Bachelor's or associate degree
- 2+ years of experience in UB-04 Follow-Up and/or Contract/Reimbursement Analysis, including investigation of pricing and reimbursement variances
- 2+ years of experience with Medicare processes and systems
- Detailed knowledge of Facility Reimbursement contracts, fee schedules, and reimbursement procedures
- Advanced MS Excel skills
Benefits
Comp & perks- Equal Opportunity Employer
- Employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations