About this role
📍 HYBRID POSITION – CHARLOTTE, NC Candidates must live in Charlotte or within a commutable distance and be available to work onsite as required.
DUTIES & RESPONSIBILITIES:
• Apply in-depth knowledge of medical claims denial and insurance follow-up to independently review accounts and take action for proper adjudication and payment.
• Manage incoming correspondence from payors and respond timely to ensure claims are processed and resolved efficiently.
• Prepare and submit payor appeals with supporting documentation; utilize external payor portals for claims management, follow-up, and appeal submission.
• Contact insurance payors via phone or electronic means to obtain claim status updates and pursue resolution.
• Interpret claim edits, rejections, and coverage guidelines to identify appropriate solutions and minimize delays in reimbursement.
• Accurately update patient accounting systems with correct demographic and insurance data, documenting all actions taken on accounts.
• Analyze denial trends, identify root causes, and assess the impact on accounts receivable; recommend or initiate corrective action as needed.
• Manage assigned work queues efficiently to meet established productivity and quality standards, preventing timely filing denials.
• Maintain up-to-date knowledge of Medicare, Medicaid, Medicare Advantage, Managed Care, and Commercial insurance billing practices, including fee schedules and consolidated billing.
• Apply understanding of ambulance medical billing, documentation requirements (e.g., PCS forms, transfer of care, certification levels), and compliance with federal and state coding guidelines.
• Write and file detailed appeals with insurance carriers, using clinical coverage policies and payer-specific documentation requirements.
• Review insurance claim forms, remittances, and correspondence to ensure accurate payment and resolve claim denials.
• Demonstrate strong analytical and critical thinking skills to apply payer-specific coverage policies effectively.
• Stay current on ambulance coding, regulatory billing guidelines, and changes in insurance laws and reimbursement policies.
• Maintain confidentiality and comply with all HIPAA and privacy standards, federal and state regulations, and the agency's compliance program.
• Collaborate cross-functionally and continuously seek ways to improve workflow, customer service, and internal operations.
• Provide quality customer service to patients, including verifying insurance, responding to inquiries, resolving account issues, and ensuring timely follow-up.
• Proficiently use billing software, clearinghouses, and relevant tools for electronic claim submission and account management.
• Demonstrate flexibility by supporting other revenue cycle functions when needed, such as registration, coding, cash posting, and payment posting.
• Maintain positive working relationships with internal departments, external payors, and the general public
EDUCATION/EXPERIENCE:
• Experience in the healthcare revenue cycle process
• Experience working insurance denials and appeals
• Familiarity with payer portals and clearinghouses
• Excellent verbal communication skills
• Demonstrated ability in the use of Microsoft products
• Ability to perceive and distinguish emotions during interactions with people via telephone and respond courteously
• Maintain acceptable attendance and adhere to scheduled work hours
• Ability to work within a team-oriented, fast-paced, customer focused environment
• HS diploma/GED required; Associate degree preferred
CERTIFICATIONS/LICENSES/REGISTRATIONS:
• Certified Ambulance Coder (initial certification only) preferred
Individuals must not be excluded from filing claims to any federal or state government payor.
SALARY RANGE: $23.23 - $29.04/hr
Interested applicants must complete the online application and upload a resume to be considered for the position. Applications will be accepted until September 25th 2026, 11:59PM EST.
If you have any further questions, please contact MEDIC Recruitment at [email protected].