Billing Rejection Specialist

Key Responsibilities

• Clearinghouse Monitoring: Daily review and management of clearinghouse portals to capture, sort, and action front-end rejections.

• Direct Payer Communication: Contact insurance companies directly via phone or web portals to investigate complex claim rejections, verify active patient eligibility, and check benefit coverage details.

• Root Cause Analysis: Investigate why claims were rejected by the clearinghouse or payer, distinguishing between demographic errors, missing insurance details, coding discrepancies, and provider credentialing mismatches.

• Claim Correction & Resubmission: Efficiently update and correct patient demographics, insurance policy numbers, CPT/ICD-10 codes, and modifiers within the practice management or EHR software before resubmitting.

• Cross-Functional Collaboration: Partner with internal staff and internal medical coders to address data capture errors and help prevent recurring rejections.

• Tracking & Reporting: Maintain accurate logs of rejected claims, common rejection trends, and resolution turnaround times, providing visibility to billing management.

Qualifications & Skills

• Experience: 1 to 3 years of professional experience in medical billing, revenue cycle operations, or high-volume healthcare administration.

• Technical Proficiency: Hands-on familiarity with major clearinghouses and electronic health record (EHR) / practice management software (e.g., Waystar, Cortex, Epic, Athenahealth, eClinicalWorks, NextGen).

• Data Accuracy: Exceptional attention to detail with strong alphanumeric data entry and verification skills.

• Industry Knowledge: Solid foundational understanding of medical terminology, health insurance structures (Medicare, Medicaid, Commercial), and CMS-1500 claim formats.

• Problem-Solving & Communication: Strong telephone etiquette and interpersonal communication skills for effective payer outreach, alongside analytical capability to diagnose billing errors independently.

• Shift Flexibility: Proven ability and commitment to reliably work the 6:00 PM to 3:00 AM IST night shift schedule.

Education & Credentials

• High school diploma or equivalent required; Associate's degree or general background in healthcare administration or medical billing preferred.

Shift: Night Shift (6:00 PM – 3:00 AM IST)-Remote India

Originally posted on Himalayas