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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare claims processing and billing, with a strong focus on insurance appeals, compliance with HIPAA regulations, and effective resolution of complex billing issues. Proficient in utilizing billing software and payer portals to ensure timely and accurate payment.
Highest-signal resume keywords
Healthcare Claims ProcessingInsurance Appeals PreparationICD-10 FamiliarityBilling Software ProficiencyStrong Investigative 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 Claims ProcessingInsurance Appeals PreparationICD-10 FamiliarityHCPCS KnowledgePayer Denial Codes UnderstandingBilling Follow-UpAccounts Receivable ManagementQuality Checks on ClaimsDocumenting Account ActivityResolving Complex Billing Issues
Soft Skills
Critical ThinkingAnalytical AbilitiesCustomer Service ExperienceIndependent WorkAdaptability
Tools & Technologies
Billing SoftwarePayer PortalsMicrosoft OfficeClaims Processing SystemWeb Platforms
Industry Keywords
Revenue Cycle ActivitiesInsurance DenialsPatient BillingCompliance with HIPAAAging Accounts ManagementSpecial ProjectsFast-Paced EnvironmentRemote Work ManagementState and Federal GuidelinesHealthcare Industry
About the role
Key responsibilities & impact- Perform revenue cycle activities related to outstanding insurance accounts receivable, insurance denials, and appeals
- Conduct insurance and patient billing follow-up to ensure prompt and accurate payment
- Perform job responsibilities according to company standards and state and federal guidelines
- Contact patients, hospitals, insurance companies, facilities, and attorneys to research claims or obtain additional insurance information
- Inquire with insurance carriers about past-due account status
- Meet or exceed productivity and quality standards
- Document account activity in the claims processing system
- Follow up on unpaid claims and insurance coverage
- Maintain workflow to minimize aging accounts
- Ensure accounts reaching collections are fully worked before external collection referral
- Complete assigned special projects
- Maintain compliance with all laws and regulations, including HIPAA
- Resolve complex accounts and escalations
- Perform quality checks on assigned claims
- Adhere to company attendance policies
- Perform additional duties as assigned
Requirements
What you’ll need- High School Diploma or equivalent required
- Associates Degree preferred
- Minimum of 2 years’ experience in healthcare claims processing, billing, or accounts receivable
- Hands-on experience preparing and submitting insurance appeals, including understanding payer denial codes and payer timely filing limits
- Familiarity with ICD-10, HCPCS, and general medical terminology
- EMS billing experience strongly preferred; experience in other medical specialties will be considered
- Proficiency with various web platforms, including billing software and payer portals
- Prior customer service experience
- Basic computer knowledge and experience using Microsoft Office
- Strong investigative and research skills, with the ability to resolve complex billing issues
- Effective critical thinking and analytical abilities
- Ability to work independently in a fast-paced, adaptive environment with minimal supervision
- Ability to independently manage all aspects of the job role, including required goals and business practices, in a remote environment
Benefits
Comp & perks- Competitive salary, commensurate with experience
- Comprehensive benefits package
- 401(k) Plan
- Remote work arrangement