Billing Representative

What You Will Do

• Charge Entry & Claim Preparation
• Enter and validate charges accurately in the billing system while meeting daily productivity expectations.
• Verify CPT, HCPCS, ICD-10 codes, units, dates of service, and provider information before claim submission.
• Apply appropriate modifiers and confirm place of service and rendering provider information.
• Attach required documentation, referrals, and authorizations prior to claim submission.
• Claim Submission & Edit Resolution
• Submit professional and behavioral health claims to the appropriate payer within timely filing requirements.
• Resolve claim edits and clearinghouse scrubber errors before submission.
• Correct front-end issues including demographic, eligibility, and registration discrepancies.
• Rebill and resubmit corrected claims for standard rejection reasons.
• Documentation & Collaboration
• Document all claim activity in AMD using standardized documentation practices.
• Escalate complex payer edits or claim issues after appropriate troubleshooting.
• Identify recurring claim edits and communicate trends to leadership.
• Collaborate with internal departments to ensure accurate and timely claim processing.

What We Need From You

• Education
• A high school diploma or GED required.
• An associate's or bachelor's degree in Healthcare Administration, Business, or a related field preferred.
• Experience
• One to three years of healthcare revenue cycle, medical billing, or claims processing experience preferred.
• Experience with Electronic Health Records (EHR) and practice management systems, preferably AMD.
• Skills & Knowledge
• Knowledge of medical billing processes, insurance claims, CPT, HCPCS, ICD-10 coding, and payer guidelines.
• Strong attention to detail with the ability to identify and resolve claim discrepancies.
• Excellent organizational, communication, and problem-solving skills.
• Ability to work independently while collaborating effectively within a team.
• Commitment to maintaining HIPAA compliance and protecting patient information.

Success Looks Like

• Achieve a 95% or higher clean claim first-pass acceptance rate.
• Maintain 95% or higher claim accuracy during quality audits.
• Meet established daily productivity goals.
• Prevent avoidable timely filing write-offs.
• Contribute to process improvements that enhance team efficiency and claim quality.

Your Work Schedule

Monday to Friday, 8 AM - 4:30 PM (Flexible)

Location

Denova Collaborative Health LLC - DHQ (Hybrid Work Model after 90 days)