Medical Billing and Revenue Cycle Specialist

Hudson Physicians Sc; Hudson (WI); Hybrid; USD 42,000 - 66,000; Full time

Job summary

Hudson Physicians Sc seeks a Medical Billing & Revenue Cycle Specialist to manage insurance claim follow-up, denial resolution, and AR management. The role collaborates with payers, patients, and internal teams to resolve claims and ensure accurate payments.

Training is conducted remotely and the position offers hybrid work in Hudson, WI. Ideal candidates have 1–2 years in Healthcare Business Office, with experience in billing, denials, and follow-up, and are proficient in ICD-10 and CMS

Qualifications

• Minimum: High School Diploma or equivalent.
• 1-2 years in Healthcare Business Office or related field.
• Experience with insurance denials, appeals, and follow-up.

Responsibilities

• Follow up on assigned accounts, claims, and aging work queues to ensure timely resolution.
• Research unpaid, underpaid, and denied claims to determine next steps.
• Communicate with insurance companies via payer portals, phone, and written correspondence.

Skills

Insurance billing

Denials & appeals handling

Accounts receivable management

Payer communications

Healthcare terminology

Education

High School Diploma or equivalent

Post-secondary education (preferred)

Job description

Job DetailsLevel: ExperiencedJob Location: Hudson, WI - Hudson, WI 54016Position Type: Full TimePosition is Full-Time Hybrid working in Hudson, WI.

JOB SUMMARY:

As a Medical Billing & Revenue Cycle Specialist, you will be responsible for insurance claim follow-up, denial resolution, and accounts receivable management. This position plays an important role in revenue generation, timely reimbursement, and maintaining a clean accounts receivable. You will work closely with insurance payers, patients, and internal teams to research and resolve outstanding claims and ensure accurate payment. The position will be primarily staffed remotely during business office hours. All training is completed remotely.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Work assigned accounts, claims, and aging work queues to ensure timely follow-up and resolution.
• Research unpaid, underpaid, and denied claims to determine the reason for non-payment and the appropriate next step.
• Communicate with insurance companies through payer portals, phone calls, and written correspondence.
• Submit corrected claims, reconsiderations, and appeals based on payer requirements.
• Review accounts for accurate insurance information, claim filing, payments, adjustments, denials, refunds, and credit balances.
• Review electronic claim status information and take appropriate action.
• Respond to patient questions related to insurance claims and billing in a professional and compassionate manner.
• Partner with coding and other Revenue Cycle team members when additional review or clarification is needed.
• Identify patterns and trends in denials and claim processing and communicate opportunities for improvement to the team.
• Stay current on payer policies and changes that may impact billing and reimbursement.
• Maintain accurate documentation and records for assigned accounts.
• Manage multiple priorities while meeting daily, weekly, and monthly deadlines.

SUPPLEMENTAL DUTIES AND RESPONSIBILITIES:

• 1. Maintain confidentiality.
• 2. Establish and maintain positive working relationships.
• 3. Work independently with minimal instruction in team environment.
• 4. Attend training sessions, in-services, departmental and facility meetings.
• 5. Adheres to the philosophy and provides comprehensive care according to a patient centered healthcare clinic.
• 6. Perform other duties and responsibilities as required or assigned by the Revenue Cycle leadership.
• 7. Ability to multi-task and meet daily, weekly and monthly deadlines.

WORKING CONDITIONS:

• 1. Subject to interruptions, imposed deadlines and frequent problem-solving activities.
• 2. May be subject to hostile and emotionally upset patients, staff, and personnel from other agencies.
• 3. Standard Office Environment.

PHYSICAL DEMANDS:

• Abide by ergonomic recommendations of the position.
• Must possess sight/hearing senses or use prosthetic devices that will enable these senses to function adequately.
• Sit for several hours.
• Repetitive motions involving use of phone and keyboard.

QualificationsEDUCATION:

• Minimum: High School Diploma or equivalent
• Desired: Post-secondary education.

EXPERIENCE:

• Minimum: 1-2 years in Healthcare Business Office.
• Desired: 2-4 years Insurance Billing,denials and follow up.

KNOWLEDGE:

• Experience working insurance denials and appeals.
• Understanding of EOBs/ERAs and insurance reimbursement.
• Knowledge of medical terminology and health insurance.
• Proficient with ICD-10 and CMS billing guidelines.