Medical Billing Specialist

Position:
Medical Billing Specialist

Location:

Remote / On-site
Department:
Revenue Cycle Management

CMCI is seeking a detail-oriented and experienced Medical Billing Specialist to oversee claims processing, revenue cycle management, and contribute valuable insights to develop AI-powered tools that enhance medical billing workflows. The ideal candidate will have expertise in medical coding, claims submission, payer interactions, and denial management, ensuring optimized billing practices for maximum reimbursement and minimal claim rejections.

• Opportunity to work with cutting-edge AI-driven billing solutions that optimize RCM efficiency.
• Work in a collaborative environment with healthcare and AI professionals.
• Competitive salary, benefits, and professional development opportunities.

• Claims Processing & Submission:
  Accurately process, review, and submit medical claims.
• Verify CPT, ICD-10, and HCPCS codes to ensure claims compliance with payer-specific policies.
• Work with clearinghouses and insurance payers to track claims and resolve denials, rejections, and underpayments efficiently.
• Revenue Cycle Management (RCM):
  Oversee the entire claims lifecycle, from eligibility verification to final payment reconciliation.
• Monitor accounts receivable (A/R) aging reports and ensure timely follow-up on outstanding claims.
• Optimize payer reimbursement rates by leveraging contractual agreements and coding best practices.
• Payer & Compliance Coordination:
  Utilize the payer lookup database to retrieve Payer IDs and transaction types for accurate claim submission.
• Ensure compliance with Medicare, Medicaid, and private insurance guidelines to prevent fraud and billing errors.
• Stay updated on coding changes, regulatory requirements, and payer policies to maintain accuracy in claims processing.
• Provide insights into billing workflows, common claim errors, and automation opportunities to improve AI-driven billing tools.
• Assist in testing and refining AI-powered RCM solutions, including automated claims scrubbing and predictive denial management.
• Collaborate with the engineering and data science teams to train AI models for enhanced claims accuracy.

Required Qualifications:

• Education & Certification:
• Associate’s or Bachelor’s degree in Health Information Management, Business, or a related field (preferred).
• Certified Professional Biller (CPB) or Certified Professional Coder (CPC) (preferred).
• Experience:
• 2+ years of experience in medical billing, claims processing, or revenue cycle management.
• Strong knowledge of CPT, ICD-10, and HCPCS coding systems.
• Experience working with Medicare, Medicaid, and commercial insurance payers.
• Technical
  
  Skills:
• Proficiency with billing and practice management software such as:
• Clearinghouse platforms:
  Emdeon, Availity, Change Healthcare, Waystar, Kareo
• Experience with ANSI X12 837 EDI claims processing.
• Strong Excel and data analysis skills for tracking claim performance.
• Familiarity with AI-based RCM tools is a plus.
• Soft Skills:
• Strong analytical and problem-solving skills for identifying claim discrepancies.
• Excellent communication and collaboration skills to liaise with providers and payers.
• Ability to work independently and in a team environment in a fast-paced setting.

Join CMCI to help revolutionize the future of AI-powered medical billing!

All qualified applicants will receive consideration for employment without regard to any characteristic protected by local, state, or federal laws, rules, or regulations