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Medical Biller Auditor

Company: Exceptional Healthcare Inc.
Location: Dallas
Posted on: May 16, 2022

Job Description:

Exceptional Healthcare is a group of 13 Emergency Centers and two community hospitals. We are a growing company that is now in need to improve our revenue cycle for continued growth. As an independent operator of emergency care in Texas and Arizona.

General Job Description

This position is responsible for auditing medical facilities and professional claims for accuracy and compliance with industry laws and contractual language on behalf of our clients. Candidates must possess a strong understanding of Medicare and Medicare guidelines. Must display a high degree of independent judgment and professional skepticism that enhances the work performed to achieve success in this position.


  • Stop Loss Claims Management
  • Review medical stop-loss claim submissions
  • Audit claims against plan document, stop loss contract, and carrier standards
  • Facilitate financing of approved claims with finance
  • Pend claims and issues denials to third party administrators where appropriate
  • Elevate complex claim issues for clinician or management review
  • Properly documents claim file
  • Claim Support
  • Compile periodic reporting for internal and external parties
  • Advise on claim projections and development
  • Quality Assurance
  • Recognize, document, and alert the appropriate supervisor of trends in claims
  • Performs self-quality monitoring in order to develop and execute plans to meet established goals ----- - Meet established turnaround time and accuracy metrics
  • Provides ongoing feedback to help optimize quality performance
  • Collaborates with others and cross-departmentally to improve or streamline procedures

    Minor Duties And Responsibilities

    Ensure all claims are submitted daily with a goal of zero errors

    Timely follow up on insurance claim status

    Reading and interpreting an EOB (Explanation of Benefits)

    Respond to inquiries by insurance companies

    Denial Management

    Meet with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles Any additional duties as requested by management

    Qualifications For The Job


    High School Diploma required

    College degree preferred


    3+ years of Claims Coding or Medical Billing experience

    Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms; Medicare Reimbursement / Denial experience preferred

    AAPC, AHIMA, NHA Coding Certification, or the LAMBDA CMRS Certification required ICD-10 Proficient is required


    Communication (written, verbal, and listening), interpersonal and analytic skills

    Ability to use software related to job responsibilities including MS Office with proficiency in Excel and Outlook


    Analytical Skills,


    Billing Knowledge

    Denial Management

    Powered by JazzHR


Keywords: Exceptional Healthcare Inc., Dallas , Medical Biller Auditor, Healthcare , Dallas, Texas

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