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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 and problem-solving skills to identify discrepancies and underpayments. Proficient in navigating Medicare, Medicaid, and Commercial insurance guidelines while maintaining compliance with HIPAA and CMS regulations.
Highest-signal resume keywords
Healthcare Billing KnowledgeAnalytical AbilitiesProblem-Solving SkillsExperience With EPIC, Cerner, MeditechEffective Communication Skills
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 SkillsDetail-Oriented ApproachDocumentation SkillsGuideline InterpretationPayment Variance InvestigationDiscrepancy Identification
Soft Skills
Effective CommunicationCollaborationAttention to Detail
Tools & Technologies
EPICCernerMeditechMS ExcelMS WordMS Outlook
Industry Keywords
HIPAA ComplianceCMS RegulationsInsurance GuidelinesHealthcare ReimbursementRemote Work Experience
About the role
Key responsibilities & impact- Examine hospital claims to verify proper reimbursement
- Identify discrepancies between expected and actual insurance-carrier reimbursement using company best practices, technology-enabled worklists, and internal tools
- 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 for 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 relevant regulations 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 for accurate guideline application and documentation
- 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 proficiency with MS Excel, Word, and Outlook
- Ability to work across multiple computer screens and software applications simultaneously
- Previous experience working in a remote environment
- Quiet, distraction-free home workspace
- Secure home internet connection exceeding 20 Mbps download and 10 Mbps upload speeds
- Workspace accommodating workstation equipment and related materials
- Must reside in the United States within an eligible listed state
- Employment eligibility in the United States
- Successful background check
Benefits
Comp & perks- Comprehensive 90-business-day training beginning on the first day
- Remote work arrangement
- Work-from-home setup
- Equal employment opportunity workplace