Medical Billing Specialist

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?

• Opportunity to work with cutting-edge AI-driven billing solutions that optimize RCM efficiency.
  
• Work in a collaborative environment with healthcare and AI professionals.
  
• Competitive salary, benefits, and professional development opportunities.
  

Key Responsibilities:

• Claims Processing & Submission:
  
• Accurately process, review, and submit medical claims.
  
• Verify CPT, ICD-10, and HCPCS codes to ensure claims compliance with payer-specific policies.
  
• Work with clearinghouses and insurance payers to track claims and resolve denials, rejections, and underpayments efficiently.
  
• Revenue Cycle Management (RCM):
  
• Oversee the entire claims lifecycle, from eligibility verification to final payment reconciliation.
  
• Monitor accounts receivable (A/R) aging reports and ensure timely follow-up on outstanding claims.
  
• Optimize payer reimbursement rates by leveraging contractual agreements and coding best practices.
  
• Payer & Compliance Coordination:
  
• Utilize the payer lookup database to retrieve Payer IDs and transaction types for accurate claim submission.
  
• Ensure compliance with Medicare, Medicaid, and private insurance guidelines to prevent fraud and billing errors.
  
• Stay updated on coding changes, regulatory requirements, and payer policies to maintain accuracy in claims processing.
  
• Technology & AI Development Support:
  
• Provide insights into billing workflows, common claim errors, and automation opportunities to improve AI-driven billing tools.
  
• Assist in testing and refining AI-powered RCM solutions, including automated claims scrubbing and predictive denial management.
  
• Collaborate with the engineering and data science teams to train AI models for enhanced claims accuracy.
  

Requirements