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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 collections, including proficiency in ICD-10, CPT, and HCPCS coding, as well as familiarity with third-party billing guidelines and patient accounting systems. Strong ability to manage claims processing, appeals, and maintain compliance with government regulations.
Highest-signal resume keywords
Medical Billing ExperienceICD-10 Coding KnowledgeCPT Coding KnowledgePatient Accounting Systems (EPIC, Cerner)Third Party Billing Guidelines
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
ICD-10CPTHCPCSNCCIUB04/1500 Claim FormsPayor ContractsClaims ResearchAppeal Letter WritingClaims ProcessingMedical Documentation Management
Soft Skills
CommunicationProblem-SolvingAttention to DetailConfidentiality
Tools & Technologies
Microsoft WordMicrosoft ExcelEMR SystemsClaim ScrubbersPatient Accounting SystemsDDE Medicare Claim System
Industry Keywords
Medical CollectionsInsurance GuidelinesClaims DenialsClinical AuditsGovernment Regulations
About the role
Key responsibilities & impact- Verify/obtain eligibility and/or authorization using payer websites, client eligibility systems, or phone
- Update patient demographics and insurance information in appropriate systems
- Research/status unpaid or denied claims
- Monitor claims for missing information, authorization, and control numbers (ICN/DCN)
- Research EOBs for payments or adjustments to resolve claims
- Contact payers by phone or written correspondence to secure claim payments
- Access client systems for payment, patient, claim, and data information
- Follow prioritization, timely filing deadline, and notation protocols
- Secure medical documentation requested by third-party insurance carriers
- Maintain patient-information confidentiality according to insurance collection guidelines and corporate policies
- Utilize provider billing manuals to obtain billing guidelines and requirements
- Write appeal letters for technical appeals
- Verify underpayment accuracy using contracts and claims data
- Prepare claims for clinical audit processing for authorization, coding, level-of-care, or length-of-stay denials
- Perform other related duties as required
- Serve as a liaison to clinical auditors, team members, hospital staff, government agencies, and health plans to facilitate prompt claim payment
Requirements
What you’ll need- 2+ years of medical collections/billing experience
- Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
- Intermediate knowledge of third party billing guidelines
- Intermediate knowledge of billing claim forms (UB04/1500)
- Intermediate knowledge of payor contracts
- Working knowledge of Microsoft Word and Excel
- Intermediate working knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
- Working knowledge of one or more of the following patient accounting systems: EPIC, Cerner (preferred)
- Working knowledge of DDE Medicare claim system (preferred)
- Knowledge of government rules and regulations (preferred)
