Website:
revstream.io
Job details:
Job Purpose
The role is responsible for ensuring accurate and timely preparation, submission, and follow-up of medical claims to maximize reimbursement and support efficient revenue cycle operations. By reviewing claims for compliance, resolving discrepancies, and managing denials, the position plays a key part in maintaining financial integrity, reducing claim rejections, and ensuring adherence to payer requirements. This role requires strong knowledge of insurance guidelines, medical billing processes, and coding standards to optimize collections and support organizational sustainability.
Principal Accountabilities
- Review claims for accuracy and insurance compliance to obtain any missing information.
- Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
- Follow up on unpaid claims within standard billing cycle timeframes.
- Check insurance payments for accuracy and compliance with contract discount.
- Call insurance companies regarding any discrepancy in payments if necessary.
- Identify and bill secondary or tertiary insurances.
- Review accounts for insurance follow-up.
- Research and appeal denied claims.
- Update cash spreadsheets and run collection reports.
Related experience/ must- have skills /specific tools/ platforms/qualifications
- Associate or bachelor’s degree in accounting, Finance, Healthcare Administration, or a related field
- 3 to 5 years of experience in Medical Billing and Revenue Cycle Management.
- Knowledge of insurance guidelines, including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems
- Knowledge of medical terminology is likely to be encountered in medical claims.
- Familiarity with basics of CPT and ICD-10 Coding.
- Knowledge and understanding of the patient’s health information confidentiality guidelines and procedures in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
- Effective communication skills for phone contacts with insurance payers to resolve issues.
- Experience working with billing software and/or practice management software
Capabilities
- Analytical Thinking: Ability to analyse EOBs (Explanation of Benefits), denials, and remittance advices.
- Communication: Strong verbal and written communication for effective follow-up and documentation.
- Detail-Oriented: Precision in recording data and resolving claim discrepancies.
- Problem-Solving: Proactively troubleshoot and resolve payment or claim issues
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