[Hiring] Claims Processing Expert @Mercor

Role Description

Oversee end-to-end medical billing and claims submission operations across professional fee and/or facility billing environments.

• Evaluate AI-generated billing outputs, claim edits, and coding validations for accuracy and payer compliance.
• Manage claims submission workflows including electronic claim generation, clearinghouse edits, and payer-specific billing requirements.
• Monitor clean claim rates, rejection rates, and first-pass acceptance rates. Develop improvement strategies.
• Coordinate with coding, CDI, and collections teams to resolve billing edits and claim rejections.
• Ensure compliance with CMS billing guidelines, HIPAA 837 transaction standards, and payer-specific billing rules.
• Annotate AI outputs and provide structured feedback to support AI training datasets.

Qualifications

• 5+ years of experience in medical billing and claims management, with at least 2 years in a management role.
• Deep knowledge of professional fee (CMS-1500/837P) and/or facility (UB-04/837I) billing requirements.
• Expertise in HIPAA 837 transaction standards, clearinghouse operations, and payer-specific billing rules.
• Strong understanding of Medicare, Medicaid, and commercial payer billing requirements.
• Proficiency with billing platforms (Epic, Athenahealth, AdvancedMD, or equivalent) and clearinghouse tools.
• Exceptional written and verbal English communication skills.
• High attention to detail with the ability to identify billing errors and compliance issues in AI-generated outputs.

Requirements

• CPC, CCS, CHFP, or CRCR certification preferred.
• Experience with automated billing platforms and RCM technology implementations.
• Background in multi-specialty physician group, hospital, or health system billing operations.
• Familiarity with AI tools and comfort evaluating AI-generated billing content.
• Experience with payer contract interpretation and billing compliance program management.

Application Process

• Upload resume
• AI interview based on your resume
• Submit form

Resources & Support

• For details about the interview process and platform information, please check: Interview Process
• For any help or support, reach out to: [email protected]