Job Summary

We are looking for an experienced Medical Billing Specialist with strong knowledge of U.S. healthcare billing, particularly Medicare Part B, AR follow-up, denial management, and clinical laboratory billing.

The ideal candidate should be able to manage the complete billing lifecycle, from insurance verification and clean claim submission through payment follow-up and denial resolution.

The primary focus of this position is to ensure claims are submitted correctly the first time by validating payer information, CPT/HCPCS codes, ICD-10 diagnosis codes, medical necessity, provider information, and Coordination of Benefits (COB).

Hands-on Medicare Part B billing experience is mandatory. Experience with laboratory billing, Medicare Part A/SNF billing, and toxicology/UDT is strongly preferred.

Key Responsibilities

- Prepare, review, and submit clean medical claims to Medicare, Medicaid/MassHealth, and commercial insurance payers.
- Verify patient eligibility, insurance coverage, payer information, and Coordination of Benefits before claim submission.
- Review claims for accurate CPT/HCPCS, ICD-10-CM, provider NPI, and payer information.
- Ensure diagnosis codes support medical necessity for the services billed.
- Review applicable Medicare LCD and payer-specific coverage requirements.
- Identify missing or incorrect information before claims are submitted.
- Submit corrected claims and resubmissions when required.
- Perform AR follow-up on unpaid, rejected, denied, and underpaid claims.
- Review EOBs and ERAs and take appropriate follow-up action.
- Investigate and resolve common CARC/RARC denials, including eligibility, medical necessity, COB, coding, duplicate claims, provider information, and non-covered services.
- Determine whether a denied claim should be corrected and resubmitted, appealed, routed to another payer, billed to a facility, or escalated.




- Prepare payer appeals and submit required supporting documentation.
- Track timely filing and appeal deadlines to prevent avoidable write-offs.
- Document all billing and follow-up activities accurately in the billing system.

Medicare Part A & Part B Billing

- Demonstrate strong working knowledge of Medicare Part B billing requirements.
- Understand the difference between Medicare Part A and Medicare Part B coverage.
- Verify Medicare coverage and eligibility before billing.
- Understand SNF consolidated billing and identify when laboratory services are included under a patient's Medicare Part A stay.
- Avoid incorrectly billing Medicare Part B for services that should be billed directly to an SNF/facility.
- Handle Medicare Part B denials and appeals for eligible outpatient services.
- Understand ABN requirements and Medicare medical-necessity rules.

Laboratory Billing Responsibilities

- Process claims for clinical laboratory services, including:
- Routine blood work
- CBC and CMP
- Lipid panels
- HbA1c
- Thyroid testing
- Toxicology / Urine Drug Testing (UDT)
- PCR and molecular testing
- Pathology services

- Ensure correct CPT/HCPCS and ICD-10 coding combinations.
- Identify Medicare frequency limitations and medical-necessity requirements before billing.
- Understand presumptive versus definitive UDT billing.
- Experience with (phone hidden) and G0480–G0483 is preferred.
- Apply applicable Medicare LCD requirements for laboratory services.





Denial Management & AR Follow-Up

- Analyze denied and rejected claims to determine root causes.
- Work common denial categories including medical necessity, eligibility, COB, duplicate claims, coding, non-covered services, and missing information.
- Handle Medicare and commercial payer follow-ups.
- Identify recurring denial patterns and escalate systemic issues.
- Follow claims through final resolution rather than only completing initial follow-up.
- Maintain accurate notes describing the issue identified, action taken, and next required step.

Required Qualifications

- 2–4+ years of U.S. healthcare medical billing experience.
- Hands-on Medicare Part B billing experience is mandatory.
- Strong knowledge of the end-to-end medical billing process.
- Experience with clean claim submission and claim scrubbing.
- Experience with AR follow-up and denial management.
- Strong understanding of CPT, HCPCS, ICD-10-CM, EOB, ERA, CARC, and RARC.
- Knowledge of Medicare medical necessity and LCD requirements.
- Experience handling corrected claims and appeals.
- Positive understanding of eligibility verification and COB.
- Knowledge of timely filing requirements.
- Experience working with EHR/EMR, practice management, clearinghouse, or billing systems.
- Strong analytical and problem-solving skills.
- Excellent written and verbal English communication.
- Ability to work during U.S. business hours.

Preferred Qualifications

- Clinical laboratory billing experience.
- Toxicology/UDT billing experience.
- Medicare Part A/SNF consolidated billing experience.
- MassHealth billing experience.
- Waystar experience.
- Experience with Medicare eligibility portals.
- Experience with direct facility/SNF billing.

Key SkillsRole & responsibilities

Preferred candidate profile

📌 Medical Billing Specialist (Hyderabad)
🏢 Staffingly
📍 Hyderabad