Medical Biller - 1.0 FTE *Hybrid/Remote Opportunity*

ZipRecruiter; Orlando (FL); Remote; USD 40,000 - 60,000; Full time

Job summary

A leading company in the healthcare sector is seeking a Medical Biller responsible for preparing and submitting insurance claims. The role requires recent hospital billing experience and knowledge of Medicaid and Medicare claim processes. Responsibilities include resolving claim denials, analyzing billing adjustments, and ensuring compliance with federal and state guidelines. Ideal candidates will possess strong problem-solving skills and be familiar with EPIC EMR.

Qualifications

• Recent experience in hospital billing required.
• Familiarity with Medicaid and Medicare claims denials.
• Knowledge of billing and coding requirements.

Responsibilities

• Investigate & resolve claim denials.
• Validate denial code/reason following EOB review.
• Document all actions taken during the appeals process.

Skills

Attention to detail

Problem-solving

Interpersonal communication

Microsoft Office

Analytical skills

Research skills

Education

High School Diploma

Tools

EPIC EMR

Job description

Job DescriptionJob Description

Summary:

The Medical Biller is responsible for preparing, reviewing, correcting, and updating insurance claims for submission to payers,

Typical Schedule:

Full Time, Monday through Friday, Days

Onsite training/onboarding will be required.

Qualifications:

Recent experience in hospital billing required. Critical Access and/or Rural Health Clinic experience a plus. Experience in charge capture, coding, revenue cycle management, patient accounting and/or physician billing a plus.

Experience with EPIC EMR .

Medical Terminology .

High School Diploma required.

Responsibilities include:

• Investigating & resolving claim denials

• Identifying denial patterns and managing insurance project resubmissions with multiple claims

• Validate denial code/reasons following explanation of benefit (EOB) review and ensure coding is accurate and reflects the procedures billed

• Analyze all coding adjustments made on EOB to ascertain accuracy and valid support

• Review Summary Plan Descriptions and related insurance documents to ascertain benefits

• Determine and execute best approach for denial resolution and processing appeal

• Ensure timeliness of all appeals according to Federal, State and plan guidelines

• Generate appeals based on the dispute reason(s)

• Document all actions taken during the appeal process and any follow-up required

• Request and obtain medical records, notes and/or copy of claim as appropriate

• Resolve appeal claims with third party payers

Knowledge, Skills & Abilities:

• Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements.

• Knowledge and use of payer medical policy and Medicare LCD/NCD criteria.

• Knowledge of billing and coding requirements

• Must have the ability to effectively utilize Microsoft Office

• Must possess excellent verbal, written and interpersonal communication skills, and able to balance multiple demands and respond to time constraints.

• Must have high-level skills in organization as well as problem solving and analytical skills.

• Capacity to manage time effectively, attention to details, and follow through.

• Well-developed research skills.

• Advanced technical skills to quickly learn hospital information systems

• Knowledge of contracting and credentialing implications on revenue cycle functions