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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates advanced knowledge of revenue cycle management, payer guidelines, and appeals processes, with a strong focus on accuracy and compliance in medical billing. Proven ability to analyze complex claims, identify trends, and implement effective strategies for resolution and recovery.
Highest-signal resume keywords
Medical Collection ExperienceRevenue Cycle ManagementPayer Guidelines KnowledgeICD-10 ProficiencyEOB Interpretation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisAppeals ProcessesDenial ManagementBilling ProceduresPayer OutreachData AnalysisAction Plan ExecutionClaim CorrectionsDocumentation AccuracyTrend Identification
Soft Skills
Attention to DetailExcellent CommunicationNegotiation SkillsTime ManagementIndependent Work
Tools & Technologies
Microsoft OfficeMedical Billing PlatformsOracle
Industry Keywords
DME ClaimsOrthopedic ClaimsMedicareMedicaidCommercial InsuranceLCD GuidelinesNCD GuidelinesCMS-1500
Tech Stack
Tools & technologiesOracle
About the role
Key responsibilities & impact- Independently manage a portfolio of high-priority and complex claims requiring advanced solutions and strategies.
- Analyze denials, overpayments and underpayments to determine root cause; execute action plans including appeals, escalations and payer outreach.
- Submit technical, clinical and medical necessity appeals at all levels, including external reviews, with supporting documentation.
- Research payer contract language, LCD/NCD guidelines and policy updates; apply findings to claims resolution and communicate relevant changes to peers and leadership.
- Identify payer trends, including systemic rejections, denials, overpayments or underpayments, and escalate issues with supporting data to payer contacts and leadership.
- Resolve escalated issues involving prepay audits, refund requests, rebills, recoupments and coordination of benefits discrepancies.
- Manage HCFA returns and claim corrections, ensuring clean resubmission per billing guidelines.
- Communicate with leadership and cross-functional teams to resolve multifaceted claim barriers.
- Ensure account documentation is accurate, detailed and audit ready across internal systems.
- Meet or exceed departmental metrics related to productivity, quality, aging resolution and cash recovery.
- Serve as a subject matter resource for junior collectors and assist leadership in driving payer compliance and revenue recovery.
Requirements
What you’ll need- High School Diploma or Equivalent Experience
- Minimum 2+ years of medical collection or revenue cycle experience with emphasis on post-billing DME or orthopedic claims.
- Advanced knowledge of payer guidelines, revenue cycle management, and appeals processes (Medicare, Medicare advantage, Medicaid, and commercial insurance payers).
- Proficiency in reading and interpreting EOBs, payer policies, LCDs, and prior authorization requirements.
- Strong working knowledge of ICD-10, HCPCs and billing procedures for CMS-1500 claim forms.
- Proficient in Microsoft Office and medical billing platforms.
- Demonstrated experience with complex denials, payer escalations, and appeals at all levels.
- Strong attention to detail with the ability to identify trends and implement corrective strategies.
- Excellent communication skills and negotiation skills with payers and internal stakeholders.
- Ability to work independently, detail-oriented with a focus on accuracy, time-management and compliance.
- Familiarity with Oracle or similar revenue cycle platforms.
- Associate’s degree preferred.
Benefits
Comp & perks- Bonus
- Benefits
- Equal employment opportunities
- Reasonable accommodations for qualified individuals with disabilities