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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in healthcare revenue cycle management, including auditing medical claims, coding accuracy, and compliance with Medicare and Medicaid billing requirements. Proven ability to analyze billing workflows, identify discrepancies, and implement improvements to enhance reimbursement outcomes.
Highest-signal resume keywords
Healthcare Revenue Cycle ManagementClaims AuditingCPT, HCPCS, ICD-10-CM CodingEpic, Oracle Health/CernerBilling Compliance
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 AuditingMedical CodingBilling AccuracyReimbursement ConsultingCPT CodingHCPCS CodingICD-10-CM CodingPayer-Specific Billing RulesRevenue Leakage IdentificationDenial Management
Soft Skills
Analytical SkillsEffective CommunicationIndependent WorkProblem-SolvingCollaboration
Tools & Technologies
EpicOracle HealthCernerEHR PlatformsBilling Platforms
Industry Keywords
Medicare Billing GuidelinesMedicaid Billing RequirementsCommercial Insurance BillingRevenue Cycle OrganizationsHealthcare Systems
Tech Stack
Tools & technologiesOracle
About the role
Key responsibilities & impact- Conduct detailed audits of medical claims, billing records, coding, and supporting clinical documentation
- Validate CPT, HCPCS, ICD-10-CM codes, modifiers, and payer-specific billing requirements
- Identify inaccurate coding, missed charges, duplicate billing, underbilling, and reimbursement discrepancies
- Verify claims meet Medicare, Medicaid, and commercial payer billing and documentation requirements
- Evaluate end-to-end billing workflows, including charge capture, claims submission, denials, and payment reconciliation
- Identify revenue leakage, missed reimbursement opportunities, and operational inefficiencies
- Analyze denied, rejected, and underpaid claims to determine root causes and recommend corrective actions
- Recommend improvements to increase billing accuracy, clean claim rates, and reimbursement capture
- Serve as a billing and reimbursement subject matter expert for healthcare system clients
- Partner with client revenue cycle and billing teams to investigate and resolve billing discrepancies
- Evaluate client billing practices and provide recommendations to improve accuracy, compliance, and reimbursement
- Support client discussions involving coding, documentation, payer requirements, and billing processes
- Provide guidance on CMS regulations, Medicare billing guidelines, and commercial payer requirements
- Assess billing compliance risks and recommend corrective actions
- Develop standardized claims audit procedures, quality assurance controls, and billing best practices
- Collaborate with Clinical Operations, Product, Technology, and Finance teams to improve billing workflows and supporting documentation
Requirements
What you’ll need- 5+ years of hands-on experience in healthcare revenue cycle management, insurance billing, medical coding, claims auditing, or reimbursement consulting
- In-depth experience with Epic, Oracle Health/Cerner, or other EHR and billing platforms
- Extensive expertise in Medicare, Medicaid, and commercial insurance billing and reimbursement requirements
- Advanced knowledge of CPT, HCPCS, ICD-10-CM coding, modifiers, and payer-specific billing rules
- Proven experience independently auditing medical claims, identifying coding errors, and resolving reimbursement discrepancies
- Demonstrated ability to identify revenue leakage, reduce denials, and improve billing accuracy and reimbursement outcomes
- Experience working with healthcare systems, physician groups, medical practices, or healthcare revenue cycle organizations
- Strong analytical skills with the ability to review complex billing data, identify trends, and translate findings into actionable recommendations
- Ability to work independently, manage consulting deliverables, and communicate effectively with internal stakeholders and healthcare system clients
Benefits
Comp & perks- Competitive compensation based on experience and impact
- Comprehensive medical, dental, and vision coverage for employees and dependents at a low cost
- Up to 35 paid days off each year
- 12 vacation days accrued annually
- Up to 9 sick/wellness days
- 12 paid company holidays
- 2 Paid Give-Back Days
- HSA and FSA account options
- 401(k) with company match after 6 months of full-time employment
- 100% match on the first 3% contributed, and 50% match on the next 2% contributed
- Collaborative, mission-driven team helping transform healthcare at scale