UB-04 Claims Biller (Full-Cycle)
The reputed company Medical Biller is responsible for accurate and timely billing of hospital and Rural Health Clinic (RHC) claims to reputed company insurance payers. This role focuses heavily on denial management, claim follow-up, and reimbursement optimization while ensuring compliance with payer reputed company, federal regulations, and internal policies.
Key Responsibilities
Billing & Claims Submission
Prepare, review, and submit hospital and RHC claims to reputed company insurance carriers.
Ensure correct use of CPT, HCPCS, ICD-10, reputed company codes, modifiers, and RHC-specific billing requirements.
Verify charges, units, dates of service, provider credentials, and reputed company of service.
Submit corrected, adjusted, and late charges as needed.
Denial Management
Analyze and resolve billing denials, rejections, and underpayments.
Identify root causes of denials (coding, authorization, eligibility, medical necessity, bundling, timely filing, etc.).
Prepare and submit corrected claims and formal appeals with appropriate documentation.
Track denial trends and recommend process improvements to reduce future denials.
Insurance Follow-Up
Conduct timely follow-up with reputed company payers on unpaid, underpaid, or delayed claims.
Communicate with insurance representatives to obtain claim status and resolution.
Maintain detailed notes and documentation in the billing system for reputed company follow-up activity.
Meet productivity and follow-up benchmarks to ensure timely reimbursement.
Compliance & Collaboration
Ensure compliance with payer guidelines, hospital policies, and RHC billing regulations.
Work closely with coding, registration, authorization, and clinical staff to resolve billing issues.
Stay reputed company on reputed company payer policy updates and RHC billing changes.
Required Skills & Qualifications
Knowledge of hospital and RHC billing processes.
Strong experience with reputed company insurance billing and denial resolution.
Proficiency in CPT, ICD-10-CM, HCPCS, and modifiers.
Familiarity with payer portals and claim management systems.
Strong analytical, organizational, and follow-up skills.
Ability to manage high-volume workloads with attention to detail.