Role & responsibilities: Technical Skills: 1. Medical Billing Systems: • Familiarity with popular billing software such as Epic, Cerner, Meditech, NextGen, ClinicalWorks, Modmed, or PHIMed. • Experience with HCFA-1500 forms, UB-04 forms, and other insurance-specific claim forms. 2. Domain Knowledge: • Handle medical billing processes for various insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. • Experience in denials management, including identifying denial reasons, appeals process, and follow-up to resolve denials promptly. • Strong understanding of insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. • Proficiency in CPT, ICD-10, and Modifiers to assign correct codes and ensure compliance with coding standards. • Demonstrate a basic understanding of revenue cycle management to optimize billing procedures and revenue generation. • Manage denials effectively by identifying reasons for denials, initiating appeals, and following up to ensure resolution and minimize revenue loss. 3. Claim Submission & Denial Management: • Proficient in claim submission through EDI (Electronic Data Interchange) or other methods. • Experience managing claim denials and rejections, appealing denied claims, and identifying the reason behind denials. • Ability to correct errors in coding or documentation to ensure proper reimbursement. 4. Compliance & Regulations: • Deep understanding of HIPAA regulations to ensure patient confidentiality and compliance. • Awareness of insurance payer guidelines, federal/state regulations, and any updates to medical billing practices. • Knowledge of Medicare/Medicaid billing guidelines and commercial payer contracts Preferred candidate profile: Specify required role expertise, previous job experience, or relevant certifications. Perks and benefits: Mention available facilities and benefits the company is offering with this job.
Key Responsibilities : Accurately assign CPT, ICD-10-CM, and HCPCS codes for multiple specialties (e.g., cardiology, radiology, general surgery, orthopedics, gastroenterology, internal medicine, etc.) Review medical records and documentation for completeness and appropriateness of coding. Ensure coding compliance with federal regulations and coding guidelines (CMS, AHA, AMA, etc.) Work closely with billing teams to resolve coding and documentation discrepancies. Maintain coding productivity and quality benchmarks. Participate in audits and provide feedback to improve coding processes. Stay updated with coding guidelines and payer-specific policies. Qualifications : Minimum 1 year of recent experience in ENM & multispecialty medical coding. Certification required: CPC, CCS, or equivalent (AAPC or AHIMA certified). Strong understanding of medical terminology, anatomy, and physiology. Proficiency with EHR/EMR systems and coding software. Ability to work independently and meet deadlines. Preferred Skills : Experience with coding for outpatient and/or inpatient services. Exposure to Risk Adjustment/HCC coding (optional). Excellent communication and analytical skills.
Job Description Should have strong knowledge in RCM and denial management. Candidate must be familiar with CMS1500 form. Should have knowledge on terms like CPTs, Modifiers, ICD codes Should have knowledge on insurance guidelines especially Medicare and Non-Medicare. Good Knowledge on Denial Scenarios Calling agents on claims resolutions and handling the denials for a closure. Ensure 100% follow up on pending claims Ensure deliverables adhere to quality standards Handling daily denials Handling more complex/aged inventory Follow the basic rules as provided on the SOP Education/ Experience Requirements Any Undergraduate/Graduation Degree and above Problem solving skills Strong verbal and written communication skills with the ability to translate information requests into practical output results Should be analytically strong & well versed with RCM benchmarks Excellent Domain Knowledge Requirement Minimum 1 Year experience in AR calling (Physician Billing) Proficiency in Microsoft office tools Willingness to work the night shift Good knowledge of denials Good Know knowledge of RCM
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