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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, with a strong understanding of ICD-10, CPT, HCPCS, and NCCI coding systems. Proficient in utilizing health information systems and adhering to compliance standards in billing processes.
Highest-signal resume keywords
Medical Billing ExperienceICD-10 KnowledgeCPT KnowledgeHealth Information SystemsThird-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
Medical CollectionsBilling ComplianceClaim EditingClaim SubmissionPatient Demographics ManagementBilling Claim FormsAuthorization VerificationBilling GuidelinesResearch and ResolutionTimely Filing Deadlines
Soft Skills
CommunicationAttention to DetailProblem-SolvingConfidentiality Maintenance
Tools & Technologies
Microsoft WordMicrosoft ExcelEMR SystemsClaim ScrubbersPatient Accounting SystemsEPICCernerMeditechDDE Medicare Claim SystemParagon
Industry Keywords
JCAHO StandardsFederal RegulationsState RegulationsLocal RegulationsPayer Contracts
Tech Stack
Tools & technologiesInvision
About the role
Key responsibilities & impact- Utilize hospital/physician systems to verify patient, billing and claim information for accuracy
- Perform compliant primary/secondary, tertiary and rebill billing functions through electronic, paper and portal submission to payers
- Edit claims to satisfy billing compliance guidelines for electronic and hardcopy submission
- Respond to emails and telephone messages
- Communicate payer, system and escalated account issues to management
- Attend meetings, training seminars and in-services
- Adhere to professional standards, hospital policies and procedures, federal, state and local requirements, and JCAHO standards
- Update patient demographics and insurance information
- Monitor claims for missing information, authorization and control numbers
- Follow prioritization, timely filing deadlines and notation protocols
- Secure medical documentation requested by third-party insurance carriers
- Maintain confidentiality of patient information
- Use provider billing manuals to obtain billing guidelines and requirements
- Verify and escalate import/export files
- Handle interim bills, overlap review and redistribution of money for correct claim creation
- Research and resolve billing rejections
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.)
- Preferred: Working knowledge of one or more of EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon
- Preferred: Working knowledge of DDE Medicare claim system
- Preferred: Knowledge of government rules and regulations
