POSITION’S ESSENTIAL RESPONSIBILITIES:

• Review and validate billing charges for accuracy, completeness, and compliance with coding guidelines and payer requirements
• Ensure timely and accurate charge capture for all surgical procedures and related services
• Monitor charge lag reports and collaborate with clinical staff to resolve missing or incomplete charges
• Notify early out program leader of charge description master (CDM) updates and pricing discrepancies
• Perform daily charge reconciliation and exception reporting
• Submit claims electronically through clearinghouses to various payors
• Monitor claims transmission reports and resolve transmission errors
• Track claim status from submission through adjudication
• Manage claim edits, rejections, and clearinghouse error resolution
• Maintain clean claim rates above 98% through systematic pre-submission validation
• Post payments accurately from electronic remittance advice (ERA) and paper EOBs
• Reconcile daily cash receipts and identify payment variances
• Process contractual adjustments, write-offs, and refunds according to established procedures
• Maintain payment posting accuracy above 99%
• Generate and analyze payment reports for management review
• Handle claim rejections and edits at the clearinghouse level before transmission to payors
• Research and resolve payment discrepancies and short payments for routine claims
• Research and resolve unidentified payments from insurance and patient sources, coordinate with patient access and billing teams to locate appropriate accounts and ensure timely clearing of payment suspense items to support accurate month-end financial reporting
• Process initial claim corrections and resubmissions through clearinghouse systems
• Collaborate with AR specialist for high-level accounts receivable issues requiring advanced resolution
• Communicate with insurance companies for basic claim status inquiries and routine payment issues
• Maintain detailed documentation of all front-end resolution activities
• Escalate complex denial patterns and unresolved payment issues to AR specialist
• Track and report rejection trends and initial resolution rates

POSITION REQUIREMENTS:

• Strong analytical and problem-solving abilities
• Excellent attention to detail and accuracy
• Effective written and verbal communication skills
• Ability to work independently and manage multiple priorities
• Customer service orientation for patient and payer interactions
• Understanding of healthcare reimbursement methodologies
• Knowledge of regulatory requirements affecting billing operations

EDUCATION AND EXPERIENCE REQUIREMENTS:

• High school diploma or GED required; Associate's degree in Health Information Management, Healthcare Administration, or related field preferred
• Current certification required: CPB (Certified Professional Biller) from AAPC or CRCR (Certified Revenue Cycle Representative) from HFMA
• CPC (Certified Professional Coder) certification preferred
• Minimum 3-5 years of healthcare billing experience with surgical hospital and/or ASC environments
• Demonstrated professional-level experience with Waystar revenue cycle management platform
• Knowledge of CPSI/TruBridge systems preferred
• Experience with HST Pathways ASC software preferred
• Proven experience in denial management and payment resolution
• Experience with multiple payer types including commercial, Medicare, and Medicaid
• Advanced proficiency in healthcare revenue cycle management systems
• Strong knowledge of medical coding (CPT, ICD-10, HCPCS)

If you're interested please reach out to Ricki at rhoffman@judge.com

Apply now