Insurance Billing Professional

Jobtailor; Holland (MO); On-site; USD 55,000 - 85,000; Full time

Job summary

Jobtailor is seeking an Insurance Billing specialist to support government and commercial payer claims, minimize denials, and optimize first-pass acceptance. The role emphasizes data-driven denial prevention, root-cause analysis, and collaboration with leadership to improve processes.

The candidate will manage EHR/billing systems, navigate payer portals, and maintain comprehensive, audit-ready account notes while supporting continuous quality improvement initiatives.

Qualifications

• High school diploma or GED or higher.
• Credentials: CPC, CPB, CBCS, COC, CIC, CRCR, HBI, HFMA certificates preferred.
• Strong written and verbal communication skills.
• Proficient with EHR/billing systems and claim editing tools.

Responsibilities

• Submit and follow up on government and commercial payer claims to secure reimbursement.
• Prevent denials by validating authorization, eligibility, medical necessity indicators, modifiers, diagnosis/procedure alignment, and required documentation.
• Review claim edits and resolve preventable edits to maximize first-pass acceptance.
• Monitor denial patterns by payer, plan, and category.
• Conduct root cause analysis and implement prevention actions with Denials Analysts and Leadership.
• Maintain payer requirement grids, reference files, tip sheets, and other denial prevention tools.
• Communicate payer policy changes, recurring denial themes, and emerging risks.
• Bill primary, secondary, and tertiary payers and initiate patient balance billing according to policy and regulations.
• Monitor assigned insurance work queues and resolve encounters, including Charge Error DOS, Adjustments, and Client Bill workqueues.
• Investigate and resolve payer rejections, denials, and underpayments.

Skills

Insurance Billing

Denial Prevention

Root Cause Analysis

EHR/Billing Systems

Excel Reporting Skills

Data Analysis

Payer Portals

Documentation Accuracy

Payer Policies

Communication Skills

Education

High school diploma or GED

CPC

CPB

CBCS

COC

CIC

CRCR

HBI

HFMA Certificates

Tools

Claim Editing Tools

Payer Portals

EHR/Billing Systems

Job description

• Submit and follow up on government and commercial payer claims to secure appropriate reimbursement
• Prevent denials by validating authorization, eligibility, medical necessity indicators, modifiers, diagnosis/procedure alignment, and required documentation
• Review claim edits and resolve preventable edits to maximize first-pass acceptance
• Monitor denial and rejection patterns by payer, plan, and category
• Conduct root cause analysis and implement prevention actions with Denials Analysts and Leadership
• Maintain payer requirement grids, reference files, tip sheets, and other denial prevention tools
• Communicate payer policy changes, recurring denial themes, and emerging risks
• Bill primary, secondary, and tertiary payers and initiate patient balance billing according to policy and regulations
• Monitor assigned insurance work queues and resolve encounters, including Charge Error DOS, Adjustments, and Client Bill workqueues
• Investigate and resolve payer rejections, denials, and underpayments
• Assist with encounters from other staff members’ work queues to prevent backlogs
• Maintain timely, complete, and audit-ready account notes and follow-up actions
• Run, distribute, and review ATB and denial-related reports; identify trends and priority actions
• Translate reporting into recommendations for training, workflow changes, and escalations
• Maintain accurate payer reference information
• Participate in continuous quality improvement initiatives
• Assist leadership with daily, weekly, and monthly audits of team members and workqueues
• Support onboarding, training, and coaching for new hires and team members
• Partner with the Denials Team and Leadership on education and standard work
• Participate in team goal setting and contribute to a collaborative, high-performing team
• Complete Leadership-requested projects accurately and on time
• Continue demonstrating proficiency in Insurance Billing and Follow-up representative/associate responsibilities

Requirements

• High school diploma/GED, or higher education
• One of the following credentials or equivalent: CPC, CPB, CBCS, COC, CIC, CRCR, HBI, HFMA certificates preferred
• Maintains credential continuing education (CE) requirements as applicable
• Strong written and verbal communication skills
• Proficient computer skills, including EHR/billing systems, claim editing tools, and payer portals
• Strong attention to detail and data accuracy
• Strong analytical skills for identifying denial trends, determining root causes, quantifying impact, and recommending corrective actions
• Strong organizational skills; ability to prioritize aged/at-risk accounts, meet deadlines, and manage high-volume work
• Critical thinking and sound judgement
• Ability to develop training materials and provide coaching/training
• Intermediate to advanced Excel/reporting skills preferred, including filters, pivots, and lookups
• Experience building or maintaining denial reference tools and supporting standard work preferred
• Maintains patient confidentiality and complies with HIPAA, payer policies, and applicable regulations

Core Competencies

Demonstrates expertise in Insurance Billing and Follow-up, with a strong focus on denial prevention, root cause analysis, and effective communication of payer policies. Proficient in utilizing EHR/billing systems and advanced Excel skills to analyze data and support continuous quality improvement initiatives.

Highest-signal resume keywords

• Insurance Billing
• Denial Prevention
• Root Cause Analysis
• EHR/Billing Systems
• Excel Reporting Skills

ATS Optimization Keywords

Hard Skills

• Claim Editing Tools
• Payer Portals
• Data Analysis
• Medical Necessity Validation
• Authorization Verification
• Denial Trend Identification
• Patient Balance Billing
• Documentation Accuracy
• Payer Requirement Maintenance
• Audit-Ready Account Notes

Soft Skills

• Strong Communication Skills
• Attention to Detail
• Organizational Skills
• Critical Thinking
• Coaching and Training Ability

Certifications & Qualifications

• CPC
• CPB
• CBCS
• COC
• CIC
• CRCR
• HBI
• HFMA Certificates

Industry Keywords

• HIPAA Compliance
• Payer Policies
• Denial Management
• Quality Improvement
• Healthcare Billing