Health Business Solutions LLC

Key Responsibilities

• Review denied medical claims to determine reasons for denial (coding errors, missing information, medical necessity, eligibility, etc.).
• Collect, organize, and verify supporting documentation needed for appeals or audits.
• Prepare and submit claim audit packets for internal review or external payor reconsideration.
• Collaborate with clinical staff, coders, and billing teams to resolve discrepancies and correct claim data.
• Maintain accurate tracking of denied claims, appeals filed, and outcomes for reporting purposes.
• Identify trends in denials and escalate recurring issues to management for process improvement.
• Ensure compliance with HIPAA, CMS, and payor guidelines.
• Assist with internal audits, quality checks, and special projects as assigned.

Qualifications

• Bachelor's degree in healthcare administration, business, or related field preferred.
• Minimum of 3 years prior experience in medical claims, billing, coding, or auditing highly desirable.
• Knowledge of ICD-10, CPT, and HCPCS coding, as well as medical terminology.
• Familiarity with payor policies, EOBs, and claim adjudication processes.
• Strong organizational skills with attention to detail and accuracy.
• Ability to work with confidential patient and claims information in compliance with HIPAA.
• Proficiency in Microsoft Office Suite and experience with claims management systems (Epic, Facets, Availity, etc. preferred).

Skills & Competencies

• Analytical thinking and problem-solving
• Strong written and verbal communication
• Time management and multitasking
• Collaboration and teamwork
• Process improvement mindset