索赔处理专家 - 全程远程 | 最高 80 美元/小时
Claims Processing Expert - Fully Remote | Upto $80/hr
关于职位
Mercor 将顶尖的创意和技术人才与领先的 AI 研究实验室连接起来。公司总部位于旧金山，我们的投资人包括 Benchmark、General Catalyst、Peter Thiel、Adam D'Angelo、Larry Summers 和 Jack Dorsey。
职位：医疗账单经理
类型：合同制
薪酬：80 美元/小时
地点：远程办公
岗位职责
- 在专业费用和/或设施账单环境中，监督端到端的医疗账单和索赔提交操作。
- 评估 AI 生成的账单输出、索赔编辑和编码验证的准确性及保险公司合规性。
- 管理索赔提交流程，包括电子索赔生成、清算所编辑和保险公司特定的账单要求。
- 监控干净索赔率、拒付率和首次通过接受率。制定改进策略。
- 与编码、CDI 和催收团队协调，解决账单编辑和索赔拒付问题。
- 确保符合 CMS 账单指南、HIPAA 837 交易标准和保险公司特定的账单规则。
- 标注 AI 输出并提供结构化反馈，以支持 AI 训练数据集。
任职要求
必备条件
- 5 年以上医疗账单和索赔管理经验，其中至少 2 年在管理岗位。
- 深入了解专业费用（CMS-1500/837P）和/或设施（UB-04/837I）账单要求。
- 精通 HIPAA 837 交易标准、清算所操作和保险公司特定的账单规则。
- 对 Medicare、Medicaid 和商业保险公司账单要求有深入了解。
- 熟练使用账单平台（Epic、Athenahealth、AdvancedMD 或同等系统）和清算所工具。
- 出色的英文书面和口头沟通能力。
- 高度关注细节，能够识别 AI 生成输出中的账单错误和合规问题。
优先考虑
- 持有 CPC、CCS、CHFP 或 CRCR 认证。
- 具有自动化账单平台和 RCM 技术实施经验。
- 多专科医生集团、医院或医疗系统账单运营背景。
- 熟悉 AI 工具，能够评估 AI 生成的账单内容。
- 具有保险公司合同解读和账单合规项目管理经验。
申请流程（需 20–30 分钟完成）
- 上传简历
- 基于简历的 AI 面试
- 提交表单
资源与支持
- 有关面试流程和平台信息的详细内容
查看英文原文
About the job
Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.
Position: Medical Billing Manager
Type:Contract
Compensation:$80/hour
Location:Remote
Role Responsibilities
- Oversee end-to-end medical billing and claims submission operations across professional fee and/or facility billing environments.
- Evaluate AI-generated billing outputs, claim edits, and coding validations for accuracy and payer compliance.
- Manage claims submission workflows including electronic claim generation, clearinghouse edits, and payer-specific billing requirements.
- Monitor clean claim rates, rejection rates, and first-pass acceptance rates. Develop improvement strategies.
- Coordinate with coding, CDI, and collections teams to resolve billing edits and claim rejections.
- Ensure compliance with CMS billing guidelines, HIPAA 837 transaction standards, and payer-specific billing rules.
- Annotate AI outputs and provide structured feedback to support AI training datasets.
Qualifications
Must-Have
- 5+ years of experience in medical billing and claims management, with at least 2 years in a management role.
- Deep knowledge of professional fee (CMS-1500/837P) and/or facility (UB-04/837I) billing requirements.
- Expertise in HIPAA 837 transaction standards, clearinghouse operations, and payer-specific billing rules.
- Strong understanding of Medicare, Medicaid, and commercial payer billing requirements.
- Proficiency with billing platforms (Epic, Athenahealth, AdvancedMD, or equivalent) and clearinghouse tools.
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to identify billing errors and compliance issues in AI-generated outputs.
Preferred
- CPC, CCS, CHFP, or CRCR certification.
- Experience with automated billing platforms and RCM technology implementations.
- Background in multi-specialty physician group, hospital, or health system billing operations.
- Familiarity with AI tools and comfort evaluating AI-generated billing content.
- Experience with payer contract interpretation and billing compliance program management.
Application Process (Takes 20–30 mins to complete)
- Upload resume
- AI interview based on your resume
- Submit form
Resources & Support
- For details about the interview process and platform information, please check:
- For any help or support, reach out to:
PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
Originally posted on Himalayas