Job DescriptionJob DescriptionSummary :The Medical Biller is responsible for preparing, reviewing, correcting, and updating insurance claims for submission to payers,Typical Schedule :Full Time, Monday through Friday, DaysOnsite training / onboarding will be required.Qualifications :Recent experience in hospital billing required.Critical Access and / or Rural Health Clinic experience a plus.Experience in charge capture, coding, revenue cycle management, patient accounting and / or physician billing a plus.Experience with EPIC EMR preferred.Medical Terminology preferred.High School Diploma required.Responsibilities include :Investigating & resolving claim denialsIdentifying denial patterns and managing insurance project resubmissions with multiple claimsValidate denial code / reasons following explanation of benefit (EOB) review and ensure coding is accurate and reflects the procedures billedAnalyze all coding adjustments made on EOB to ascertain accuracy and valid supportReview Summary Plan Descriptions and related insurance documents to ascertain benefitsDetermine and execute best approach for denial resolution and processing appealEnsure timeliness of all appeals according to Federal, State and plan guidelinesGenerate appeals based on the dispute reason(s)Document all actions taken during the appeal process and any follow-up requiredRequest and obtain medical records, notes and / or copy of claim as appropriateResolve appeal claims with third party payersKnowledge, Skills & Abilities :Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements.Knowledge and use of payer medical policy and Medicare LCD / NCD criteria.Knowledge of billing and coding requirementsMust have the ability to effectively utilize Microsoft OfficeMust possess excellent verbal, written and interpersonal communication skills, and able to balance multiple demands and respond to time constraints.Must have high-level skills in organization as well as problem solving and analytical skills.Capacity to manage time effectively, attention to details, and follow through.Well-developed research skills.Advanced technical skills to quickly learn hospital information systemsKnowledge of contracting and credentialing implications on revenue cycle functions.