Medical Billing Specialist

About the role

We are seeking a detail-oriented Medical Biller to support revenue cycle operations by managing billing and denial work queues within Epic. This position is responsible for researching and resolving insurance claim denials, making appropriate claim corrections, obtaining necessary documentation, and ensuring timely claim resubmissions.

Responsibilities

• Work assigned denial and billing work queues daily.
• Investigate insurance claim denials and determine appropriate resolution steps.
• Obtain supporting clinical documentation when required for claim correction and resubmission.
• Apply claim corrections, including modifiers when appropriate.
• Resubmit denied claims and monitor claim status through resolution.
• Review outstanding billing issues and take corrective action to ensure timely reimbursement.
• Communicate with providers and billing departments to clarify claim information and documentation requirements.
• Review surgery-related billing items to ensure complete and accurate documentation.
• Maintain compliance with commercial, Medicare, Medicaid, and HMO payer requirements.

Requirements

• Minimum of 1 year of medical billing or billing follow-up experience.
• Experience working insurance denial work queues.
• Proficiency with Epic EMR (strongly preferred).
• Knowledge of commercial insurance, Medicare, Medicaid, and HMO products.
• Ability to interpret denial reasons and take appropriate corrective action.
• Strong problem-solving, analytical, and organizational skills.
• Excellent attention to detail and ability to manage multiple work queues simultaneously.
• Ability to work independently and effectively in a high-volume environment.