Medical Billing Specialist

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.  

As our Medical Billing Specialist, you will investigate and examine denial accounts using established methods to resolve issues. Every day, you will apply appropriate methods and techniques as established internally to resolve applicable issues, follows through with unresolved accounts, and provide feedback to leadership.

You will utilize your computer skills to be able to trouble-shoot issues as they arise within the assigned specialization group. Having an analytical mindset will aide you in conducting research analysis to seek and obtain appropriate information in determining overpayments on accounts.

Having prior experience in healthcare billing and claims will provide you with an advantage in comprehending the department. We will teach you our industry-leading technology and a variety of medical terminology to perform at your best and feel good about what you do.

Here's What You Can Expect:

• Investigates and examines source of denials utilizing knowledge of charge master, AS4, ICD-9 coding, CPT coding and EDI billing.

• Reads and interprets expected reimbursement information from EOB's and learns legal parameters pertaining to all State and Federal Laws that pertain to the plan benefits pertaining to the EOB.

• Works closely with third party payers to resolve unpaid claims in proving medical necessity of the patient's admission.

• Works with HIM and PAS across the enterprise in resolving adverse benefit determinations.

• Submits technical appeals and understands the CAU scope document.

• Maintains and follows all HIPAA and confidentiality requirements.

Required Qualifications

• High School diploma

• Demonstrated excellent analytical, fact-finding, problems solving and organizational skills as well as the ability to communicate, both verbally and in writing with staff, patients, and insurance plan administrators

• Demonstrated ability to work successfully in a team setting.

For this US-based position, the base pay range is $14.11 - $21.88 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and …