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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare billing, coding, and reimbursement methodologies, with strong analytical abilities to interpret complex guidelines. Effective communication and problem-solving skills are essential for collaboration with internal teams and external stakeholders.
Highest-signal resume keywords
Healthcare Billing KnowledgeAnalytical AbilitiesInvestigative SkillsExperience With EPICFamiliarity With HIPAA Regulations
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Healthcare BillingCoding MethodologiesReimbursement MethodologiesAnalytical SkillsProblem-Solving Skills
Soft Skills
Effective CommunicationDetail-Oriented Approach
Tools & Technologies
EPICCernerMeditechMS ExcelMS WordMS Outlook
Industry Keywords
Medicare GuidelinesMedicaid GuidelinesCommercial Insurance GuidelinesHealthcare Reimbursement RegulationsAudit Compliance
About the role
Key responsibilities & impact- Examine hospital claims to verify accurate reimbursement for services provided
- Use company best practices, technology-enabled worklists, and internal tools to identify discrepancies between expected and actual insurance reimbursements
- Investigate payment variances, coding errors, billing discrepancies, and incorrect payer-policy application
- Contact insurance companies to obtain missing information, explain and resolve underpayments, and arrange payment or adjustment processing on behalf of clients
- Prepare and submit letters, emails, faxes, online inquiries, appeals, adjustments, reports, and payment postings
- Maintain documentation of underpayment root causes, trends, outcomes, and lessons learned
- Participate in discussions, meetings, and brainstorming sessions to improve processes
- Uphold ethical standards and comply with healthcare reimbursement regulations, guidelines, and organizational policies
- Perform other duties as assigned
Requirements
What you’ll need- High school diploma or equivalent required
- Investigative and problem-solving skills to identify underpayments and discrepancies
- Knowledge of healthcare billing, coding, and reimbursement methodologies
- Strong analytical abilities to interpret complex guidelines and their implications for claims reimbursement
- Ability to navigate and interpret Medicare, Medicaid, and Commercial insurance guidelines
- Detail-oriented approach to applying guidelines and documenting findings for audit and compliance purposes
- Effective communication skills for collaboration with internal teams, payers, and external stakeholders
- Experience with healthcare billing software and databases, including EPIC, Cerner, and Meditech
- Familiarity with HIPAA, CMS regulations, and state-specific healthcare reimbursement requirements
- Moderate computer proficiency with MS Excel, Word, and Outlook
- Technical proficiency using multiple computer screens and software applications simultaneously
- Previous experience working in a remote environment
- Quiet, distraction-free home work environment
- Secure home internet connection with download speeds greater than 20 Mbps and upload speeds greater than 10 Mbps
- Workspace accommodating workstation equipment and related materials
- Must reside in the United States within one of the listed eligible states
- Eligibility to work in the United States
- Successful completion of a background check
Benefits
Comp & perks- Comprehensive training beginning on the first day and lasting 90 business days
- Remote work arrangement
- Work-from-home setup