Medical Billing

3 days ago

Denver, United States AimHire Full time

Position: Medical Billing & Collections Specialist - Reimbursement (Remote working mountain time hours)

Location: Denver, CO

(excluding California, North Dakota, Washington, Wyoming, and Puerto Rico)


We are looking for a detail-oriented and experienced Medical Billing & Collections Specialist to join our client’s team. In this role, you will be responsible for overseeing the entire claims process, from billing to follow-up, ensuring timely resolution of claims with government and commercial payors. You will handle denied claims, manage appeals, investigate partial payments, and resolve claim rejections while maintaining compliance with industry guidelines and organizational policies. Strong communication and analytical skills are essential, as you will interact with payors and collaborate with internal teams to ensure accurate claim processing and reimbursement.



This is a contract to hire position with a strong possibility of going permanently paying between $23-$28/hourly based upon experience


Key Responsibilities:


  • Manage the health and status of insurance claims billed to government and commercial payors, ensuring timely resolution through persistence, attention to detail, and clear communication.
  • Requires strong knowledge and experience in the full revenue cycle process, including traditional Medicare, Medicare HMO, traditional Medicaid, Medicaid HMOs, contracted commercial plans, and non-contracted (out-of-network) claims.
  • Experience with Durable Medical Equipment (DME) billing is preferred.

Claim Follow-Up

  • Investigate claim status via payor portals or by contacting payors.
  • Identify and resolve issues such as missing information, errors, or timely filing concerns.
  • Correct and resubmit claims as needed, adhering to payor guidelines.
  • Document all actions in the billing system and monitor follow-up progress.

Denial Management

  • Analyze and understand denial reasons.
  • Verify accuracy and gather necessary supporting documents.
  • Contact payors to clarify denials and determine next steps (corrections, resubmission, or appeal).
  • Submit appeals or corrected claims with proper documentation.
  • Track and document actions in the billing system.

Partial Payment Review

  • Investigate partial payments to verify payment accuracy and determine patient responsibility.
  • Review Explanation of Benefits (EOBs) and contracts to ensure compliance with contractual rates.
  • Address discrepancies through corrections, appeals, or adjustments.
  • Update billing records and document all actions in the system.

Resolving Claim Rejections

  • Review rejection reasons using codes and messages to verify claim details (patient information, billing codes, insurance).
  • Investigate rejected claims to validate critical details.
  • Correct errors, update information, and gather supporting documents.
  • Resubmit claims following payer guidelines, ensuring timely filing.

Performance and General Duties

  • Follow organizational policies and use internal resources for guidance.
  • Adhere to quality procedures and support continuous improvement initiatives.
  • Apply workflow efficiencies to manage tasks and prioritize effectively.
  • Address open cases related to reimbursement invoices.
  • Gain proficiency in relevant systems (e.g., Oracle, Salesforce, ProChant Pulse, Brightree) to resolve inquiries and document actions.

Work Prioritization

  • Use the daily work driver (such as Daily AR Pivot, ProChant Pulse, Excel) to prioritize tasks.
  • Filter worklists and focus on high-priority accounts.



Requirements:


  • Expertise in Medicare, Medicaid, and commercial payor regulations.
  • Proven ability to independently write appeal letters for denied or underpaid claims.
  • Experience with submitting retroactive authorization requests.
  • Excellent communication skills to participate in reimbursement calls and address related inquiries.
  • Ability to interpret and explain Explanation of Benefits (EOBs), in-network/out-of-network benefits, coinsurance, deductibles, and provider contractual agreements.
  • Knowledge of Accounts Receivable (A/R) principles, cash posting, medical billing procedures (including HCPCS and ICD-10 codes), medical collections, and claims processing guidelines.
  • Bachelor's degree in a related field with 2-3 years of experience in medical billing and collections, or High School Diploma/GED with 6+ years of experience in medical billing and collections.


AimHire is an equal opportunity employer.

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