Full-Time Sr. Medical Claims Billing Specialist

• Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; writing rules where appropriate to stop errors from occurring.
• Denial management - investigating denial sources, resolving and appealing denials which may include contacting payer representatives.
• Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques.
• Collaborate internal teams (Performance, Operations, Sales) as well as care center staff when appropriate.
• At times, support large care center go lives which may include overnight travel.
• Works closely with our Revenue Optimization team, to support efforts to ensure reimbursement is in line with payer contract agreements.
• Performs Denial analysis utilizing the Trizetto platform.
• Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality
• Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals.
• Other duties as assigned.

• High School Graduate
• 5+ years experience in a physician medical billing office
• Experience with major payers such as Anthem, Medicare/Medicaid, United Healthcare preferred
• Experience supporting MD, VA, Washington DC preferred
• Athena EHR experience required
• Experience working from home preferred
• Advanced Google Sheets skills preferred
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims
• Must comply with HIPAA rules and regulations

• Comfortable speaking in front of groups
• Excellent written and verbal communication
• Willingness to train and mentor other team members
• Great time management skills
• Ability to work independently and multi-task in a fast paced environment

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