Job Details

Job Description
Position: Medical Billing Specialist
Location: Remote / On-site
Department: Revenue Cycle Management

Overview:

CMCI is seeking a detail-oriented and experienced Medical Billing Specialist to oversee claims processing, revenue cycle management, and contribute valuable insights to develop AI-powered tools that enhance medical billing workflows. The ideal candidate will have expertise in medical coding, claims submission, payer interactions, and denial management, ensuring optimized billing practices for maximum reimbursement and minimal claim rejections.

Why Join CMCI?

• Opportunityto work with cutting-edge AI-driven billing solutions that optimizeRCM efficiency.
• Work in acollaborative environment with healthcare and AI professionals.
• Competitivesalary, benefits, and professional development opportunities.

Key Responsibilities:

• ClaimsProcessing & Submission:
• Accuratelyprocess, review, and submit medical claims.
• Verify CPT,ICD-10, and HCPCS codes to ensure claims compliance withpayer-specific policies.
• Work withclearinghouses and insurance payers to track claims and resolve denials,rejections, and underpayments efficiently.
• Revenue CycleManagement (RCM):
• Oversee theentire claims lifecycle, from eligibility verification to final paymentreconciliation.
• Monitoraccounts receivable (A/R) aging reports and ensure timely follow-upon outstanding claims.
• Optimizepayer reimbursement rates by leveraging contractual agreements andcoding best practices.
• Payer &Compliance Coordination:
• Utilize thepayer lookup database to retrieve Payer IDs and transactiontypes for accurate claim submission.
• Ensurecompliance with Medicare, Medicaid, and private insuranceguidelines to prevent fraud and billing errors.
• Stay updatedon coding changes, regulatory requirements, and payer policies tomaintain accuracy in claims processing.
• Technology& AI Development Support:
• Provideinsights into billing workflows, common claim errors, and automationopportunities to improve AI-driven billing tools.
• Assist intesting and refining AI-powered RCM solutions, including automated claimsscrubbing and predictive denial management.
• Collaboratewith the engineering and data science teams to train AI models forenhanced claims accuracy.

Requirements

Required Qualifications:

• Education& Certification:
• Associate'sor Bachelor's degree in Health Information Management, Business, or arelated field (preferred).
• CertifiedProfessional Biller (CPB) or Certified Professional Coder(CPC) (preferred).
• Experience:
• 2+ years ofexperience in medical billing, claims processing, or revenue cyclemanagement.
• Strongknowledge of CPT, ICD-10, and HCPCS coding systems.
• Experienceworking with Medicare, Medicaid, and commercial insurance payers.
• TechnicalSkills:
• Proficiencywith billing and practice management software such as:
• ElectronicHealth Records Systems: Epic, Cerner, Athenahealth
• Clearinghouseplatforms: Emdeon, Availity, Change Healthcare, Waystar, Kareo
• Experiencewith ANSI X12 837 EDI claims processing.
• Strong Exceland data analysis skills for tracking claim performance.
• Familiaritywith AI-based RCM tools is a plus.
• Soft Skills:
• Stronganalytical and problem-solving skills for identifying claimdiscrepancies.
• Excellentcommunication and collaboration skills to liaise with providers andpayers.
• Ability towork independently and in a team environment in a fast-pacedsetting.

Join CMCI to help revolutionize the future of AI-powered medical billing!

All qualified applicants will receive consideration for employment without regard to any characteristic protected by local, state, or federal laws, rules, or regulations