Billing Rejection Specialist

Accountabilities

• Monitor clearinghouse rejections:Review clearinghouse portals daily to identify, categorize, prioritize, and action front-end claim rejections, ensuring issues are addressed promptly.

• Communicate with insurance payers:Contact insurance companies by telephone or through online portals to investigate complex rejections, verify patient eligibility, confirm active insurance coverage, and clarify benefit details.

• Investigate rejection causes:Perform root cause analysis to identify issues involving patient demographics, missing or incorrect insurance information, medical coding discrepancies, provider credentialing mismatches, and other billing errors.

• Correct and resubmit claims:Update patient demographic details, insurance policy numbers, CPT and ICD-10 codes, modifiers, and other claim information within electronic health record (EHR) or practice management systems before resubmission.

• Collaborate with internal teams:Work closely with billing colleagues, medical coders, and relevant operational staff to resolve data capture errors, clarify coding issues, and reduce recurring claim rejections.

• Maintain accurate records:Document rejected claims, investigation findings, corrective actions, resubmission status, and resolution timelines to ensure accurate tracking and accountability.

• Identify rejection trends:Monitor recurring billing issues and rejection patterns, provide clear reporting to billing management, and contribute to process improvements that increase claim accuracy and operational efficiency.

• Support timely reimbursement:Prioritize outstanding rejections and follow through on corrective actions to help reduce avoidable delays in the healthcare reimbursement cycle.

Requirements

• Professional experience:1–3 years of experience in medical billing, healthcare revenue cycle operations, or high-volume healthcare administration.

• Billing systems knowledge:Hands-on familiarity with major clearinghouse platforms and electronic health record or practice management systems, such as Waystar, Cortex, Epic, Athenahealth, eClinicalWorks, or NextGen.

• Medical billing fundamentals:Foundational knowledge of medical terminology, health insurance structures, Medicare, Medicaid, commercial insurance plans, and CMS-1500 claim formats.

• Claims processing expertise:Understanding of claim rejection workflows, eligibility verification, billing corrections, CPT and ICD-10 coding basics, insurance data validation, and claim resubmission procedures.

• Data accuracy and attention to detail:Excellent alphanumeric data entry and verification skills, with the ability to identify inconsistencies and maintain accurate patient, insurance, and claim information.

• Analytical and problem-solving abilities:Strong investigative skills and the ability to independently diagnose billing errors, determine root causes, and implement appropriate corrective actions.

• Communication and payer outreach:Professional telephone etiquette, clear written and verbal communication, and strong interpersonal skills for effective interaction with insurance representatives and internal colleagues.

• Organization and time management:Ability to manage a high volume of rejected claims, prioritize competing tasks, maintain detailed records, and meet resolution timelines.

• Education:High school diploma or equivalent is required. An associate degree or additional education or training in healthcare administration or medical billing is preferred.

• Shift availability:Willingness and ability to work the required night shift from6:00 PM to 3:00 AM ISTconsistently.

• Remote work readiness:Ability to work independently in a remote environment while maintaining productivity, accuracy, and effective communication with the wider team.

Benefits

• Remote work:Work from home in India, offering flexibility and eliminating the need for daily office commuting.

• Competitive compensation:Access a competitive compensation and benefits package, with specific salary details to be confirmed during the hiring process.

• Career development:Opportunities to strengthen medical billing, claims management, and healthcare revenue cycle expertise while developing professionally.

• Collaborative work culture:Join a supportive and cooperative environment that encourages teamwork, curiosity, and knowledge sharing.

• Professional growth:Gain exposure to established software solutions and operational practices across healthcare and related industries.

• Workplace flexibility:Benefit from an environment that values employee contributions, encourages autonomy, and supports career development.

• Inclusive workplace:Work in an environment committed to equal opportunity, respect, and fair consideration for qualified candidates.

• Employee support:Reasonable accommodations are available for candidates who require them during the recruitment process.