The Role
Processes and resolves medical billing claim errors, rejections, and resubmissions to ensure clean, timely claims. Verifies patient demographics, insurance eligibility, and coordination of benefits; maintains payer access and Athena master files; manages EDI, ERA, and EFT enrollments. Tracks productivity and accuracy metrics, identifies billing trends, and communicates issues to management. Requires medical billing, revenue cycle application, coding, and medical terminology knowledge.
Summary Generated by Built In
- Maintains productivity and accuracy metrics per department expectations.
- Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
- Reviews insurance rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding rejections.
- Correct and identify billing errors and resubmit claims to insurance carriers.
- Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
- Assist in identifies and communicating trends and/or potential issues to management team.
- Payer website user access maintenance.
- Responsible for system maintenance of Athena master files including referring provider information, accurate insurance plan information and payer enrollments.
- Responsible for EDI, ERA and EFT enrollments for all payers.
EDUCATION
- High school diploma or GED
EXPERIENCE
- Minimum two to three years of experience in medical billing. Experienced candidates will have prior experience working claim errors in a claims management system. Prefer candidates with knowledge of ERA/EFT enrollment as well as ANSI formatting.
REQUIREMENTS
- Requires demonstrated knowledge of revenue cycle applications. Prefer prior experience configuring revenue cycle vendor-supplied software.
KNOWLEDGE
- Knowledge of ICD-10, HCPS, and CPT codes, medical terminology, and billing practices.
- Advanced computer knowledge, including Window based programs.
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Skills Required
- High school diploma or GED
- Two to three years of medical billing experience
- Experience working claim errors in a claims management system
- Knowledge of revenue cycle applications
- Knowledge of ICD-10, HCPCS, CPT codes, medical terminology, and billing practices
- Advanced computer knowledge, including Windows-based programs
- Knowledge of ERA and EFT enrollment
- Knowledge of ANSI formatting
- Experience configuring revenue cycle vendor-supplied software
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The Company
What We Do
HOPCo partners with physician practices, hospitals, health systems, and payors to improve musculoskeletal care, including orthopedics, spine, and related specialties. Its integrated platform combines clinical pathways, practice and service-line management, outcomes reporting, data analytics, and value-based care programs. The company helps align providers, improve operational and financial performance, expand access, and enhance patient outcomes while managing and reducing the overall cost of care.
