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Billing Representative
HealthriseBilling Representative managing day-to-day billing activities for Hospital and Medical Group claims. Resolving claim issues and ensuring compliance with payer guidelines for timely operations.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in revenue cycle medical billing, including claim generation, denial management, and compliance with payer guidelines. Proficient in analyzing billing trends and optimizing reimbursement through effective communication and problem-solving skills.
Highest-signal resume keywords
Revenue Cycle Medical BillingDenial ManagementCPT, ICD-10, HCPCS CodingEpic ExperienceCertified Professional Biller (CPB)
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claim GenerationClaim TransmissionBilling OperationsPayer Guidelines ComplianceData AnalysisReimbursement OptimizationClaim Rejection ResolutionPatient Accounting System DocumentationBilling Trend ReportingInsurance Follow-Up
Soft Skills
Excellent Communication SkillsStrong Organizational SkillsTime-Management SkillsInterpersonal SkillsCustomer Service Skills
Tools & Technologies
Microsoft OfficeEpicPatient Accounting System
Certifications & Qualifications
Certified Professional Biller (CPB)Certified Medical Reimbursement Specialist (CMRS)
Industry Keywords
Healthcare Financial ServicesMulti-Site Healthcare SystemInsurance ContractsPayer Billing TimelinesRegulatory Compliance
About the role
Key responsibilities & impact- Performs day-to-day billing activities for Hospital (HB) and/or Medical Group (PB) claims, including claim generation and transmission
- Responsible for primary, secondary, and tertiary billing, resolving claim edits and rejections, and ensuring claims are transmitted in compliance with payer guidelines
- Serves as part of the Billing team to ensure timely, accurate, and compliant billing operations
- Identifies routine billing issues and resolves or escalates them as appropriate
- Maintains working knowledge of state and federal laws related to insurance contracts and payer billing timelines
- Investigates and addresses overpayment and underpayment accounts to optimize reimbursement
- Applies payer rules, contracts, schedules, and related data to ensure claims are billed accurately and timely
- Researches payer trends and provides feedback to improve billing accuracy and operational efficiency
- Tracks and reports denial types and root causes, recommending process improvements
- Analyzes, categorizes, and resolves claim rejections from commercial, government, and managed care payers
- Documents all actions and follow-up activities in the patient accounting system
- Responds to patient and payer inquiries or refers them appropriately
- Prepares and submits reports documenting billing trends, outcomes, and claim activity
- Interprets data, draws conclusions, and reviews findings with supervisor
- Cross-trains in various functions to enhance service delivery
- Maintains knowledge of applicable federal, state, and local laws and regulations
- Performs other duties as assigned
Requirements
What you’ll need- High school diploma or Associate degree in Accounting, Business Administration, or a related field
- Minimum of two (2) to three (3) years of experience in revenue cycle medical billing, insurance follow-up, and denial management within one of the following settings: Hospital or clinic, Health insurance company or managed care organization, Healthcare financial services environment
- Equivalent combination of education and experience may be considered
- Experience in a complex, multi-site healthcare system preferred
- Excellent written and verbal communication skills
- Strong organizational and time-management skills with high attention to detail and accuracy
- Strong interpersonal and customer service skills
- Basic proficiency in Microsoft Office (Outlook, Word, PowerPoint, Excel)
- Completion of regulatory and mandatory certifications preferred
- Comfortable working in a collaborative, shared-leadership environment
- Previous experience with Global Partner vendors preferred
- Experience using Epic
- Familiarity with CPT, ICD-10, and HCPCS coding
- Strong problem-solving skills
- Ability to work independently, meet deadlines, and maintain high attention to detail
- Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or equivalent certification preferred
Benefits
Comp & perks- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options