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 Perks (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 appe

📌 Medical Billing Specialist (Hyderabad)
🏢 Staffingly
📍 Hyderabad