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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in resolving insurance claims and denials while maximizing cash collections. Proficient in medical insurance terminology, ICD-10, and CPT codes, with strong organizational and communication skills.
Highest-signal resume keywords
Medical Insurance KnowledgeICD-10 And CPT Code FamiliarityClaims Resolution SkillsData Entry And Word ProcessingAttention To Detail
About the role
Key responsibilities & impact- Research and resolve insurance or contract claims to maximize cash collections and minimize denials and lost revenue
- Work on individual and project denial and claim assignments
- Resolve claim edits and denials
- Maintain worklists and assignments at acceptable levels based on performance targets, KPIs, and quality scores
- Conduct insurance or contract follow-up, interface with payers, communicate with internal and external business partners by phone, and use web-based tools
- Escalate items promptly
- Identify opportunities to improve department workflows and cross-functional processes
- Contribute to developing and maintaining company-wide payer matrices and updating Standard Operating Procedures
- Participate actively in team meetings
- Maintain knowledge of current government and carrier regulations relevant to the industry
- Model the organization’s core values
- Perform and assist with other department duties as needed
Requirements
What you’ll need- High school diploma or equivalent
- Knowledge of and skill in using personal computers in a Windows environment, emphasizing basic word processing and data entry onto spreadsheet programs
- Knowledge of medical insurance and its terminology
- Basic knowledge of ICD-10 and CPT codes
- Ability to work independently and as an effective team contributor
- Ability to pay close attention to detail
- Ability to identify, research, and solve problems and discrepancies
- Ability to communicate courteously and professionally
- Ability to maintain confidentiality
- Ability to process assigned duties in an organized manner
- Ability to perform basic mathematical calculations such as adding, subtracting, multiplying, and dividing
- Ability to effectively perform in a multi-task work environment
- Ability to work overtime when needed
- Ability to work effectively in remote settings
- Experience in medical insurance, billing experience, or equivalent training or education is helpful, but not required
- Standard office or remote work environment requiring prolonged periods of computer use
- May occasionally require lifting files or materials up to 15 pounds
- Visual and manual dexterity required for computer and claim documentation work
Benefits
Comp & perks- Medical, dental, and vision insurance options
- Health savings accounts (HSA) and flexible spending accounts (FSA)
- 401(k) employee and employer contributions
- Paid time off, including vacation, sick leave, and company holidays
- Paid parental leave & family support benefits
- Short-term and long-term disability insurance
- Life and accidental death & dismemberment (AD&D) insurance
- Employee assistance programs & wellness resources
- Bonus eligibility, equity, or other incentive programs, depending on the role
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ResolutionMedical Insurance TerminologyICD-10 CodingCPT CodingData EntryBasic Mathematical CalculationsWorkflow ImprovementPerformance Target ManagementProblem SolvingConfidentiality Maintenance
Soft Skills
Effective Team ContributorProfessional CommunicationOrganizational SkillsAttention To DetailMulti-tasking Ability
Tools & Technologies
Windows EnvironmentWeb-based ToolsSpreadsheet ProgramsStandard Operating Procedures
Industry Keywords
Insurance ClaimsCash CollectionsDenials ManagementPayer InterfaceGovernment Regulations