Insurance Billing Associate

• Prepare, submit, and manage electronic and paper insurance claims to third-party payers
• Analyze and resolve claim rejections daily in the hospital clearinghouse system
• Analyze and resolve claim edits in the Hospital’s EHR system
• Analyze denied claims and resubmit corrected claims
• Perform billing-related tasks, including special rebilling initiatives/projects
• Monitor claim processing and follow up with payers after 45 days when processing has not been initiated or received
• Investigate and resolve payer claim denials, identify root causes, and implement corrective actions
• Review and address patient and insurance correspondence within one business day
• Manage payer relationships and reimbursement activities through phone, secure portals, and payer meetings
• Monitor policy changes and prepare and submit untimely appeals
• Maintain accurate documentation of billing activity in the billing system
• Adhere to departmental and Hospital performance metrics, including A/R goals, productivity benchmarks, and quality audit requirements
• Investigate outstanding debit and credit balances and collaborate with stakeholders on resolutions
• Manage communications with payers and internal departments to resolve billing inquiries
• Attend mandatory training and education to remain current on best practices, coding changes, and regulatory updates

Requirements

• High school diploma/GED, or higher education
• Minimum two years in hospital or professional billing or revenue cycle operations
• Healthcare experience preferred
• Customer service experience preferred, including face-to-face and telephone interactions
• Working knowledge of federal/state regulations and payer-specific requirements, including Medicare, Medicaid, and fiscal intermediaries
• Strict compliance with HIPAA guidelines
• Ability to attend mandatory internal/external training and education

Core Competencies

Demonstrates expertise in managing electronic and paper insurance claims, analyzing claim rejections, and maintaining compliance with federal and state regulations. Proficient in building payer relationships and resolving billing inquiries while adhering to performance metrics and quality standards.

Highest-signal resume keywords

• Insurance Claims Management
• Revenue Cycle Operations
• Healthcare Compliance
• Payer Relationship Management
• Claim Denial Resolution

ATS Optimization Keywords

Hard Skills

• Claim Analysis
• Billing Procedures
• EHR System Proficiency
• A/R Management
• Regulatory Compliance

Soft Skills

• Customer Service
• Communication
• Problem Solving

Industry Keywords

• HIPAA Compliance
• Medicare
• Medicaid
• Payer-Specific Requirements
• Healthcare Experience

Tools & Technologies

• Hospital Clearinghouse System
• Billing System
• Secure Portals