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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in laboratory billing appeals, including a strong understanding of insurance policies, healthcare regulations, and coding guidelines. Proficient in managing multiple tasks while ensuring compliance with industry regulations and maintaining exceptional attention to detail.
Highest-signal resume keywords
Laboratory Billing Appeals ExperienceInsurance Policies KnowledgeHealthcare Regulations ComplianceAppeals Process ExpertiseMicrosoft Office Suite Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Review and AnalysisAppeal Documentation ManagementDenial Trend AnalysisCoding Guidelines ApplicationPayor Policies Understanding
Soft Skills
Attention to DetailOrganizational AbilitiesEffective PrioritizationCommunication Skills
Tools & Technologies
XifinMicrosoft ExcelMicrosoft WordMicrosoft OutlookMicrosoft Teams
Industry Keywords
HIPAA ComplianceMedicaidManaged MedicaidHealthcare Providers CommunicationBilling System Tracking
About the role
Key responsibilities & impact- Review and analyze denied claims to determine the basis for denial and assess appeal potential.
- Communicate with healthcare providers and insurance representatives to gather necessary documentation for appeals.
- Ensure all payor required documentation is submitted with each appeal and tracked in billing system.
- Monitor and follow up on submitted appeals to ensure timely resolution.
- Apply healthcare regulations, payor policies, and coding guidelines to maintain compliance in the appeals process.
- Identify and analyze denial trends, recommending process improvements to reduce future denials.
- Research payor-specific appeal processes to ensure proper steps are followed.
- Collaborate with clinical teams, market access and insurances representatives to resolve appeals issues.
Requirements
What you’ll need- 3-5 years of experience in laboratory billing appeals.
- Strong understanding of insurance policies, healthcare regulations, medical terminology, and coding.
- Expertise in appeals process for major insurance plans, Medicaid, and Managed Medicaid.
- Ability to manage multiple tasks and prioritize effectively.
- Knowledge of industry regulations, including HIPAA.
- Experience with Xifin is a plus.
- Exceptional attention to detail and organizational abilities.
- Proficiency in Microsoft Office Suite (Excel, Word, Outlook, and Teams) for reporting and documentation.
- Ability to support EST hours.
Benefits
Comp & perks- Paid Time Off (PTO)
- Health, Dental, Vision and Life insurance
- 401k Retirement Savings Plan
- Employee Stock Purchase Plan
- Employee Discounts
- Voluntary benefits
- Programs for parents and parents-to-be