Billing Representative at AAIT Health RCM LLC

Description

AAIT is seeking a full-time Billing Representative who is detail-oriented and experienced Billing Representative with a strong background in medical billing, coding, and insurance processes. The ideal candidate will be skilled in medical terminology, procedure coding, cost estimation, and insurance appeals. This role requires accuracy, excellent communication skills, and the ability to work with both patients and payers to ensure timely and correct reimbursement.

ESSENTIAL FUNCTIONS

1) Accurately process and submit medical claims to insurance companies, government payers, and other third-party organizations.

2) Perform medical coding using ICD-10, CPT, and HCPCS standards for a variety of procedures and diagnoses.

3) Generate and communicate cost estimates for procedures based on insurance coverage and contract agreements.

4) Review and verify accuracy of billing data prior to claim submission.

5) Research and resolve billing discrepancies or claim denials.

6) Prepare and submit insurance appeals, ensuring compliance with payer guidelines.

7) Communicate with patients regarding billing questions, payment responsibilities, and insurance coverage.

8) Maintain up-to-date knowledge of medical terminology, payer requirements, and compliance regulations (HIPAA, CMS, etc.).

9) Collaborate with clinical staff and providers to ensure accurate coding and documentation.

10) Track accounts receivable and follow up on outstanding claims to maximize revenue.

Requirements

CORE COMPETENCIES

· Experience with Medicare/Medicaid billing and commercial insurance.

· Knowledge of coding and appeals processes.

· Ability to work independently and manage multiple tasks in a fast-paced environment.

· Customer service experience in a healthcare setting.

· Familiarity with medical terminology, payer reimbursement guidelines, and healthcare regulations.

REQUIRED  EDUCATION, EXPERIENCE, AND/OR CERTIFICATIONS

The position requires a high school diploma, associate’s degree in healthcare administration, Billing & Coding, or related field preferred. plus 2 years of relevant experience within medical billing, coding, and insurance follow-up. Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification strongly preferred. Strong knowledge of ICD-10, CPT, and HCPCS coding systems. Familiarity with medical terminology, payer reimbursement guidelines, and healthcare regulations. Familiarity with Epic, Meditech and/or PrognoCis EMR systems. Experience creating cost estimates for medical procedures. Skilled in preparing and submitting appeals for denied claims. Proficiency with medical billing software and electronic health record (EHR) systems. Strong attention to detail, problem-solving, and organizational skills. Excellent written and verbal communication skills.