[ref. n29196324] Infinit-O - Sr Medical Biller Specialist - AR, Claims ( Hybrid setup | Nightshift)

Our world-class Net Promoter Score of 75 reflects our commitment to excellence and client satisfaction.

But what truly sets us apart is our culture. At Infinit-O, diversity, equity, and inclusion are the foundation of innovation and sustainable growth. We embrace differences, empower perspectives, and create equal opportunities for everyone. Our people-first approach has earned us the

Great Place To Work Certification three times, and as a B Corp Certified company, we’re dedicated to making a positive impact not just in business but in the communities we serve.

With a highly engaged and innovative team, we don’t just optimize processes; we also create meaningful change.

This role is critical to ensuring accurate claim submission, timely payment, and effective denial management, with a specific focus on navigating the complexities of Medicaid billing.

Key Responsibilities:

• Claim Generation and Submission:
• Retrieve coded procedures and patient data from the EHR system.
• Review claims for accuracy and completeness, verifying that all necessary information (patient demographics, provider details, coded procedures, diagnoses) is present and correct before submission.
• Prepare and submit electronic and paper claims to the relevant Medicaid payers and clearinghouses in a timely manner.
• Accounts Receivable (A/R) Management:
• Proactively monitor and follow up on the status of all submitted claims to ensure timely payment.
• Identify and resolve outstanding A/R balances by contacting Medicaid payers and investigating claim status.
• Analyze Explanation of Benefits (EOBs) and Remittance Advices (RAs) to understand payment details, denials, and rejections.
• Denial Management and Appeals:
• Investigate and triage denied or rejected claims to determine the root cause of the issue (e.g., coding errors, eligibility issues, timely filing).
• Correct and resubmit claims with corrected information.
• Prepare and submit formal appeals with supporting documentation for claims that are incorrectly denied.
• Maintain a detailed log of denial trends to identify and report systemic issues.
• Payment Posting and Reconciliation:
• Accurately post payments received from Medicaid payers to the appropriate patient accounts.
• Ensure all contractual adjustments and write-offs are applied correctly.
• Reconcile payment discrepancies and ensure account balances are accurate.
• Compliance:
• Maintain up-to-date knowledge of Medicaid billing regulations, coding guidelines, and state-specific policies.
• Ensure all billing and claims handling procedures are compliant with HIPAA and other relevant regulations.

Required Skills and Qualifications:

• Experience:
• Proven experience as a medical biller, with a minimum of 3+ years of hands-on experience in a dedicated claims and A/R follow-up role.
• Specific experience with Medicaid billing is essential. Knowledge of [Client's State] Medicaid program is highly preferred.
• Demonstrated success in reducing denial rates and improving collections.
• Technical Skills:
• Proficiency with various Electronic Health Record (EHR) and practice management systems.
• Familiarity with billing and clearinghouse software.
• Strong computer skills, including proficiency with Microsoft Office Suite (Excel).
• Knowledge:
• In-depth knowledge of the entire revenue cycle management process.
• Strong understanding of medical terminology, CPT, ICD-10, and HCPCS coding as they relate to claim review and denial management.
• Comprehensive knowledge of HIPAA and other healthcare compliance regulations.
• Soft Skills:
• Exceptional attention to detail and a high level of accuracy.
• Excellent analytical and problem-solving skills to effectively troubleshoot claim issues.
• Strong verbal and written communication skills for interacting with payers and internal staff.
• Ability to work independently, manage a high volume of claims, and meet deadlines.
• A proactive and persistent approach to A/R follow-up.