Billing Rejection Specialist

Accountabilities: Monitor clearinghouse rejections: Review clearinghouse portals daily to identify, categorize, prioritize, and action front-end claim rejections, ensuring issues are addressed promptly. Communicate with insurance payers: Contact insurance companies by telephone or through online portals to investigate complex rejections, verify patient eligibility, confirm active insurance coverage, and clarify benefit details. Investigate rejection causes: Perform root cause analysis to identify issues involving patient demographics, missing or incorrect insurance information, medical coding discrepancies, provider credentialing mismatches, and other billing errors. Correct and resubmit claims: Update patient demographic details, insurance policy numbers, CPT and ICD-10 codes, modifiers, and other claim information within electronic health record (EHR) or practice management systems before resubmission. Collaborate with internal teams: Work closely with billing colleagues, medical coders, and relevant operational staff to resolve data capture errors, clarify coding issues, and reduce recurring claim rejections. Maintain accurate records: Document rejected claims, investigation findings, corrective actions, resubmission status, and resolution timelines to ensure accurate tracking and accountability. Identify rejection trends: Monitor recurring billing issues and rejection patterns, provide clear reporting to billing management, and contribute to process improvements that increase claim accuracy and operational efficiency. Support timely reimbursement: Prioritize outstanding rejections and follow through on corrective actions to help reduce avoidable delays in the healthcare reimbursement cycle. Requirements Professional experience: 1–3 years of experience in medical billing, healthcare revenue cycle operations, or high-volume healthcare administration. Billing systems knowledge: Hands-on familiarity with major clearinghouse platforms and electronic health record or practice management systems, such as Waystar, Cortex, Epic, Athenahealth, eClinicalWorks, or NextGen. Medical billing fundamentals: Foundational knowledge of medical terminology, health insurance structures, Medicare, Medicaid, commercial insurance plans, and CMS-1500 claim formats. Claims processing expertise: Understanding of claim rejection workflows, eligibility verification, billing corrections, CPT and ICD-10 coding basics, insurance data validation, and claim resubmission procedures. Data accuracy and attention to detail: Excellent alphanumeric data entry and verification skills, with the ability to identify inconsistencies and maintain accurate patient, insurance, and claim information. Analytical and problem-solving abilities: Strong investigative skills and the ability to independently diagnose billing errors, determine root causes, and implement appropriate corrective actions. Communication and payer outreach: Professional telephone etiquette, clear written and verbal communication, and strong interpersonal skills for effective interaction with insurance representatives and internal colleagues. Organization and time management: Ability to manage a high volume of rejected claims, prioritize competing tasks, maintain detailed records, and meet resolution timelines. Education: High school diploma or equivalent is required. An associate degree or additional education or training in healthcare administration or medical billing is preferred. Shift availability: Willingness and ability to work the required night shift from 6:00 PM to 3:00 AM IST consistently. Remote work readiness: Ability to work independently in a remote environment while maintaining productivity, accuracy, and effective communication with the wider team. Benefits Remote work: Work from home in India, offering flexibility and eliminating the need for daily office commuting. Competitive compensation: Access a competitive compensation and benefits package, with specific salary details to be confirmed during the hiring process. Career development: Opportunities to strengthen medical billing, claims management, and healthcare revenue cycle expertise while developing professionally. Collaborative work culture: Join a supportive and cooperative environment that encourages teamwork, curiosity, and knowledge sharing. Professional growth: Gain exposure to established software solutions and operational practices across healthcare and related industries. Workplace flexibility: Benefit from an environment that values employee contributions, encourages autonomy, and supports career development. Inclusive workplace: Work in an environment committed to equal opportunity, respect, and fair consideration for qualified candidates. Employee support: Reasonable accommodations are available for candidates who require them during the recruitment process.