Billing Executive

Overview

We are seeking a meticulous Billing Executive responsible for managing medical billing operations, including insurance claim submission, follow-ups, denial resolution, appeals, and auditing patient accounts. This role demands accuracy in billing, timely reimbursements, adherence to regulatory standards, and resolving discrepancies in claims and payments effectively.

Primary Responsibilities

• Prepare, review, and submit precise medical bills and insurance claims within mandated deadlines.
• Track claim status and liaise with insurance firms, TPAs, and other payers to facilitate prompt payments.
• Analyze denied, rejected, or underpaid claims to determine root causes and necessary corrections.
• Compose and submit appeal letters with relevant clinical, medical, and billing documents to contest claims.
• Collaborate with medical records, coding, and clinical staff to address claim denials and billing discrepancies.
• Manage appeal progress and maintain comprehensive records of outcomes and resolutions.
• Conduct thorough audits of patient accounts to validate charges, payments, adjustments, write-offs, and outstanding amounts.
• Detect billing errors, revenue loss, procedural inefficiencies, and risks related to compliance.
• Assure compliance with payer agreements, regulations, and internal protocols throughout billing and claims operations.
• Suggest and execute corrective measures based on audit and billing analyses.
• Maintain open communication with insurance entities and payers about claims, appeals, eligibility verification, authorizations, and payment issues.
• Verify patient insurance details including eligibility, coverage, benefits, and pre-authorization as required.
• Precisely record insurance and patient payments, adjustments, and write-offs into billing software.
• Generate and maintain detailed reports on aging accounts, denials, claims, payments, and audits for managerial review.
• Assist with month-end billing procedures, account reconciliations, and the completion of audit cycles.
• Identify and implement improvements in billing and denial handling processes to boost revenue, optimize collections, and minimize claim rejections.
• Ensure the confidentiality and accuracy of patient and financial data documentation.

Qualifications

• Bachelor’s degree in Commerce, Accounting, Healthcare Administration, or a related discipline.
• 2 to 5 years of professional experience in medical billing, healthcare claims processing, denial management, or appeals; fresh graduates with applicable knowledge are also welcome to apply.
• Solid understanding of medical billing workflows and insurance claim procedures.
• Strong analytical abilities, problem-solving aptitude, and meticulous attention to detail.
• Effective written and verbal communication skills.
• Capability to work autonomously and coordinate efficiently with both internal teams and external stakeholders.
• Proficiency in Microsoft Office suite and familiarity with billing or healthcare management software preferred.