[Hiring] Medical Claims Follow-Up & Billing Specialist @CREATIVE GLOBAL CONSULTING

Role Description

This position manages the end-to-end medical billing cycle with primary focus on claims follow-up, denial management, and payment posting. You'll be the bridge between clinical services rendered and actual revenue collected, working directly with insurance companies, clearinghouses, and internal teams to resolve claim issues and maximize reimbursement.

Qualifications

• 2+ years hands-on medical billing experience with demonstrated claims follow-up expertise across multiple payer types
• Working knowledge of CPT, ICD-10, and HCPCS coding
• Proficiency with practice management systems
• Insurance verification and authorization processes
• Denial management skills
• Payment posting accuracy
• Strong written/verbal communication
• Basic Excel skills

Requirements

• Certification (CPC, CPB, CPMA, or similar)
• Knowledge of credentialing/enrollment processes

Tasks

• Daily claims follow-up on unpaid/pending claims 30+ days old - calling payers, documenting interactions, resolving claim holds
• Denial analysis and resolution - identifying root causes, correcting and resubmitting claims, filing appeals with supporting documentation
• Payment posting and reconciliation - posting insurance payments/adjustments, identifying underpayments, researching payment discrepancies
• Insurance verification for scheduled appointments - confirming coverage, benefits, authorization requirements
• Patient billing support - generating patient statements, handling billing inquiries, setting up payment plans when needed
• Aging report management - working assigned AR buckets systematically, prioritizing high-dollar and timely filing deadline claims
• Coordination with clinical and front office staff - clarifying documentation issues, requesting missing information for claims
• Clearinghouse monitoring - reviewing rejection reports, fixing claim errors, ensuring clean claim submission
• Appeals and reconsideration requests - writing effective appeals with clinical documentation, tracking appeal status
• Payer correspondence - requesting claim status, corrected claim forms, overpayment resolution
• Documentation in PM system - maintaining detailed notes on all follow-up actions, payer conversations, and claim resolutions
• Reporting - tracking KPIs like days in AR, denial rates, collection percentages, clean claim rates
• Credentialing support - assisting with provider enrollment updates when impacting claim processing