Key skills
CCommunicationNegotiationAccount Management
About this role
Role Overview
- Recover medical claim overpayments through phone, email, and fax outreach
- Analyze claims data to identify overpayments and determine recovery actions
- Handle provider disputes, appeals, and complex collection scenarios
- Coordinate with clients and providers to process adjustments and reversals
- Maintain accurate follow-ups to ensure timely resolution
- Develop effective collection strategies to maximize recovery
- Communicate clearly with internal teams and external partners
Requirements
- Minimum 2 years of medical billing and/or insurance collections experience and account management
- Strong understanding of Medical claims processing and reimbursement
- Medicare (Parts A, B, C, D), Medicaid, and commercial insurance
- Coordination of Benefits (COB)
- Claim denials, appeals, and rebilling processes
- Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA)
- CPT and ICD-9/10 coding
- Healthcare settings (inpatient, outpatient, pharmacy, etc.)
- Ability to identify and explain overpayment types (duplicates, contractual, PPO, bundled claims, etc.)
- Must be able to successfully complete a background check and drug screening
- Associate degree or equivalent combination of education and experience
- Strong analytical, organizational, and problem-solving skills
- Excellent verbal and written communication
- Ability to manage high call volume and work independently
- Proficiency in Microsoft Office (Word, Excel, Outlook)
- Strong customer service and negotiation skills
Benefits
- health insurance coverage
- voluntary dental and vision programs
- life and disability insurance
- a retirement savings plan
- paid holidays
- paid time off (PTO) or vacation and/or sick time