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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical billing and coding, with a strong focus on claim submission, follow-up, and appeals processes. Proficient in utilizing insurance payer systems and maintaining compliance with healthcare regulations.
Highest-signal resume keywords
Medical Billing ExperienceClaim Denial ResolutionInsurance Payer SystemsStrong Communication SkillsEHR System Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claim SubmissionClaims Follow-UpDenial ManagementAppeals PreparationCoding Error ResolutionEligibility VerificationProcess ImprovementDocumentation AccuracyMedical CodingAccounts Receivable Follow-Up
Soft Skills
Verbal CommunicationWritten CommunicationProblem SolvingAttention to DetailCollaboration
Tools & Technologies
Insurance Payer PortalsMedical Billing SoftwareNextGen EHRMS Office (Word, Excel)
Certifications & Qualifications
Medical Billing and Coding CertificationAssociate’s Degree in Medical Billing and Coding
Industry Keywords
MedicareMedicaidCommercial InsuranceHealthcare RegulationsPayer-Specific Guidelines
About the role
Key responsibilities & impact- Review and follow up on unpaid, denied, or underpaid medical claims with insurance carriers
- Utilize payer portals, phone calls, and email communications to resolve outstanding claims
- Research and resolve claim discrepancies, including coding errors and eligibility issues
- Identify root causes of claim denials and initiate appeals or corrections
- Maintain accurate documentation of all follow-up actions in the system
- Collaborate with billing and coding teams to prevent future claim issues
- Communicate with patients regarding claim status and balances when necessary
- Prepare and submit timely appeals for denied claims with appropriate documentation
- Ensure compliance with healthcare regulations, payer-specific guidelines, and company policies
Requirements
What you’ll need- Strong knowledge of claim submission, follow-up, denials, and appeals
- Ability to identify patterns, resolve claim issues, and improve processes
- Strong verbal and written communication skills
- Ability to manage high volumes of claims with accuracy
- Experience with insurance payer systems, portals, and medical billing software
- Minimum of 2 years of experience in medical billing, coding, or accounts receivable follow-up
- High school diploma or equivalent
- Associate’s degree or certification in medical billing and coding preferred
- Proficiency in MS Office (Word, Excel)
- Experience with the EHR system, NextGen
- Strong knowledge of Medicare, Medicaid, and commercial insurance policies
- Candidates must reside in CO, FL, KS, MA, MI, MO, NM, OR, PA, SC, VA, WY, TX, or NC
Benefits
Comp & perks- PTO Accruals Start at 3 Weeks
- Comprehensive Medical and Dental Insurance
- Company-Paid Optical Allowance
- Company-Paid Routine Eye Care
- Short-Term and Long-Term Disability Insurances
- Educational Allowance
- Paid Holiday Program
- 401K with Company Match
