Medical Billing & Insurance Specialist – High-Dollar Claims & Inpatient Billing (Hybrid, Full-Time) - 240427

Job Overview

We are seeking an experienced Medical Billing & Insurance Specialist with a strong background in high-dollar hospital claims, Medicare Exhaust cases, and inpatient facility billing. This role requires expertise in handling complex claims exceeding $100K in Maryland and $500K in Washington, DC, working with UB-04 billing, and managing Coordination of Benefits (COB) conflicts. The ideal candidate will have extensive experience in hospital revenue cycle management, insurance appeals, and payer dispute resolution.

The position offers a full-time hybrid schedule, working four days remotely and one day in the office after the training period. All employees are required to work onsite 5 days a week for training purposes (first 3-4 months).

Key Responsibilities

• Handle high-dollar inpatient facility claims, ensuring proper billing and reimbursement for accounts exceeding $100K in Maryland and $500K in Washington, DC.
• Process and follow up on Medicare Exhaust claims, COB denials, and other complex inpatient billing cases.
• Investigate and resolve insurance claim denials, including appeals for underpayments, non-covered services, and coordination of benefits issues.
• Work directly with insurance companies and hospital billing systems to ensure claims are processed accurately and paid timely.
• Analyze payer trends to identify reimbursement issues and recommend corrective action.
• Complete daily UB-04 billing and ensure compliance with hospital reimbursement policies.
• Meet performance benchmarks for claims resolution, denials management, and high-dollar claim collections.

Required Qualifications

• Must have experience handling high-dollar hospital accounts exceeding $100K in Maryland and $500K in Washington, DC.
• Extensive knowledge of Medicare Exhaust claims, inpatient billing, and Coordination of Benefits processes.
• Strong experience with UB-04 billing for inpatient and hospital-based claims.
• Minimum one to two years’ experience in hospital patient accounting, medical billing, or revenue cycle management.
• Proficiency in hospital billing systems such as Epic, Cerner, Meditech, and Microsoft Excel and Word.
• Ability to resolve complex payer issues and follow up on unpaid claims.
• Excellent communication, problem-solving, and organizational skills.

Job Type & Schedule

• Full-time hybrid position with four days remote and one day in the office.
• All employees are required to initially work onsite 5 days a week for training purposes (first 3-4 months).

If you meet the qualifications, apply today to make an impact in hospital revenue cycle operations!