Healthcare Billing and Denials Coordinator

Overview

Responsibilities

• Analyze explanation of benefits forms to identify the specific reasons for insurance claim denials.
• Submit formal appeals to insurance companies supported by clinical documentation and medical necessity letters.
• Correct billing errors related to patient demographics, insurance information, or procedural coding.
• Communicate with clinical staff to obtain missing information required for accurate claim processing.
• Monitor aging accounts receivable reports to ensure timely follow-up on outstanding claims.
• Update internal billing systems with current insurance regulations and payer-specific requirements.
• Identify systemic billing issues and recommend workflow improvements to reduce future denial rates.

Qualifications

• Extensive knowledge of ICD-10, CPT, and HCPCS medical coding systems is essential.
• Proficiency in electronic health record software and revenue cycle management platforms is required.
• Experience navigating various insurance portals and understanding diverse payer reimbursement policies.
• Strong analytical skills to interpret complex medical billing data and identify trends.
• Certified Professional Coder or Certified Professional Biller designation from an accredited body like AAPC.

Nice to have

• Bachelor degree in Healthcare Administration or a related business field.
• Advanced certification in medical auditing or revenue integrity.
• Previous experience working within a specific medical specialty such as oncology or orthopedics.

Work environment

• Work is primarily performed in an office or home-office setting involving long periods of computer use.
• The role requires frequent telephone and email interaction with insurance representatives and medical providers.
• Standard business hours are typical, though month-end reporting deadlines may necessitate occasional overtime.
• Performance is often measured by specific metrics such as the clean claim rate and days in accounts receivable.

Benefits & growth

• Compensation typically includes a base salary supplemented by performance-based bonuses tied to revenue recovery.
• Career progression often leads to roles such as Revenue Cycle Manager, Billing Manager, or Compliance Officer.
• Employers frequently cover the costs of continuing education units required to maintain professional certifications.
• Remote work opportunities are increasingly common as healthcare systems centralize their administrative functions.