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Billing and Claims Specialist
Wellstar Health System. Prepare and submit clean electronic and paper claims to third-party payers .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical billing processes, including claim submissions, payer interactions, and compliance with CMS and HIPAA regulations. Proficient in CPT and ICD-10 coding, with strong analytical and problem-solving skills to resolve billing issues effectively.
Highest-signal resume keywords
Medical Billing ExperienceCPT Coding KnowledgeICD-10 Coding KnowledgeHIPAA ComplianceEpic EMR Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claim SubmissionPayer InteractionBilling ReportingClaims ResolutionCPT CodingICD-10 CodingPatient AccountingDenial ManagementRegulatory ComplianceProcess Improvement
Soft Skills
Communication SkillsCustomer Service SkillsProblem SolvingTime ManagementIndependence
Tools & Technologies
Epic EMRClearinghouse SystemsClaim Scrubber EditsPatient Accounting Systems
Industry Keywords
MedicareMedicaidCommercial InsuranceRailroad MedicareCMS RulesBilling PracticesPatient Privacy
About the role
Key responsibilities & impact- Prepare and submit clean electronic and paper claims to third-party payers
- Analyze, research, and independently resolve claim submission edits and payer rejections
- Obtain information from medical records and apply CMS rules, CPT coding guidelines, and departmental procedures
- Follow up with clearinghouse Change Healthcare and address support issues
- Coordinate patient eligibility processes through third-party sources
- Document and explain billing activity in the patient accounting system
- Identify and resolve patient billing issues and manage denial and insurance follow-up
- Attach payer-required documentation and mail paper claims
- Issue adjusted, corrected, and rebilled claims
- Resolve payer rejections, ICN claim errors, Master File errors, retro-review issues, transfer work queues, and miscellaneous work queue errors
- Review and override external clearinghouse edits
- Complete Railroad Medicare claim submissions
- Identify opportunities for system and process improvement
- Maintain patient confidentiality and privacy in accordance with HIPAA
- Communicate professionally with patients, families, peers, healthcare teams, HIM, Revenue Integrity, Patient Access, Patient Financial Services, and referral agencies
- Attend staff meetings, in-services, and continuing education
- Assist with special projects and performance improvement initiatives
- Maintain required competencies and comply with Wellstar policies, standards of work, and code of conduct
Requirements
What you’ll need- High School Diploma / GED
- Minimum 1 year medical billing experience, including knowledge of billing related reporting
- Experience working with medical payers including Medicare, Medicaid, and commercial insurance
- Working knowledge of CPT and ICD-10 coding systems
- Knowledge of medical billing and collection practices
- Ability to meet deadlines and be results oriented
- Good communication and customer service skills
- Strong problem solving and analytical aptitude
- Excellent time management skills and capacity to work independently
- Knowledge of HIPAA guidelines/regulations
- Ability to follow CMS rules and regulations, CPT coding guidelines, departmental policies and procedures, and regulatory requirements
- Ability to maintain confidentiality and patient privacy
- Ability to interact with patients/families with varied developmental and sociocultural backgrounds
- Ability to use telephone, email, and other communication devices
- Ability to work with Epic EMR, external claim scrubber edits, clearinghouse systems, and patient accounting systems
- Ability to perform claims work involving Medicare, Medicaid, commercial insurance, and Railroad Medicare
Benefits
Comp & perks- Support to do more meaningful work
- More rewarding life
- Staff meetings, in-services, and continuing education
- Participation in system performance improvement initiatives
- Supportive work environment
- Full-time employment