Overview
This role involves supporting the Revenue Cycle Medical Billing Appeal team by reviewing denied and underpaid claims for formal appeal and dispute processes with payors. The position can be remote or on-site within the United States.
Responsibilities
- Review Explanation of Benefits (EOB), denial letters, and payor correspondence to classify the type of appeal required.
- Gather, prepare, and review documentation and forms needed to submit appeals according to payor guidelines.
- Engage patients via phone and/or mail to obtain information related to the appeal process.
- Document details, requirements, and deadlines of each appeal in billing software.
- Manage daily workflow through reports to ensure timely processing of accounts.
- Follow up with payors regarding the status of appeals promptly.
- Identify payor issues within the appeal process and collaborate with leadership on potential improvements and workflow solutions.
Requirements
- Fluent in English.
- Minimum of one (1) year of advanced medical billing experience.
- Professional written and verbal communication skills.
- Proficient with computers and related technology.
- Ability to work independently with minimal supervision and collaboratively as part of a team.
Preferred Qualifications
- High school diploma or equivalent, or significant relevant work experience.
- Experience working in a call center environment.
- Above average knowledge of insurance billing guidelines and policies.
- Experience with commercial insurance appeal and reconsideration processes.
Skills
- Knowledge of healthcare billing procedures, reimbursement, third-party payer regulations, documentation, and standards.
- Ability to understand and interpret Explanation of Benefits (EOB) from payors.
- Strong problem-solving skills and attention to detail.
- Ability to make timely decisions.
- Excellent internal and external customer service skills.
- Commitment to meeting deadlines with limited supervision.
Compensation & Schedule
- Hourly rate: $20
- Bonus eligible
- Full-time schedule: Monday through Friday, 8:00 AM to 4:00 PM Central Time
Location
- Remote or on-site within the United States