We are seeking an experienced Medical Billing & Insurance Specialist with a strong background in high-dollar hospital claims, Medicare Exhaust cases, and inpatient facility billing. This role requires expertise in handling complex claims exceeding $100K in Maryland and $500K in Washington, DC, working with UB-04 billing, and managing Coordination of Benefits (COB) conflicts. The ideal candidate will have extensive experience in hospital revenue cycle management, insurance appeals, and payer dispute resolution.

The position offers a full-time hybrid schedule, working four days remotely and one day in the office.

• Handle high-dollar inpatient facility claims, ensuring proper billing and reimbursement for accounts exceeding $100K in Maryland and $500K in Washington, DC.
• Process and follow up on Medicare Exhaust claims, COB denials, and other complex inpatient billing cases.
• Investigate and resolve insurance claim denials, including appeals for underpayments, non-covered services, and coordination of benefits issues.
• Work directly with insurance companies and hospital billing systems to ensure claims are processed accurately and paid timely.
• Analyze payer trends to identify reimbursement issues and recommend corrective action.
• Complete daily UB-04 billing and ensure compliance with hospital reimbursement policies.
• Meet performance benchmarks for claims resolution, denials management, and high-dollar claim collections.

• Must have experience handling high-dollar hospital accounts exceeding $100K in Maryland and $500K in Washington, DC.
• Extensive knowledge of Medicare Exhaust claims, inpatient billing, and Coordination of Benefits processes.
• Strong experience with UB-04 billing for inpatient and hospital-based claims.
• Minimum one to two years' experience in hospital patient accounting, medical billing, or revenue cycle management.
• Proficiency in hospital billing systems such as Epic, Cerner, Meditech, and Microsoft Excel and Word.
• Ability to resolve complex payer issues and follow up on unpaid claims.
• Excellent communication, problem-solving, and organizational skills.

• Full-time hybrid position with four days remote and one day in the office.

This role is only for candidates with strong experience in high-dollar hospital claims, Medicare Exhaust billing, and inpatient UB-04 billing. If you meet these qualifications, apply today to make an impact in hospital revenue cycle operations.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.