A medical billing specialist resume should show which claims you handled, how you investigated unpaid items, and what you corrected or referred for review. Name the practice setting, billing system, payer records, and follow-up you actually used. Keep claim submission, payment, and coding decisions distinct.
Talia Monroe and every employer, school, and career detail below are fictional. This sample follows a Pittsburgh, Pennsylvania, biller handling outpatient physician claims after an earlier billing assistant role. It illustrates resume wording, not instructions for resolving a particular insurance claim. Replace the sample facts with your own verified experience.
Talia Monroe
Medical Billing Specialist
(412) 555-0168talia.monroe@example.comPittsburgh, PA
Summary
Medical billing specialist supporting outpatient physician claims since 2023, with earlier billing assistant experience. Uses athenaOne worklists and payer portals to investigate rejected and unpaid claims, review remittances, and document follow-up. Routes coding questions and appeal recommendations to the responsible staff with supporting records.
Experience
- Review rejected professional claims in athenaOne, compare subscriber details with registration records and payer responses, and correct verified demographic or insurance-entry errors. Track the corrected claim through submission and the next response. (note 1)
- Research denied claims using denial reasons on remittances, claim history, and payer portals. Send coding questions to the coding team and proposed appeals with supporting correspondence to the billing lead, recording the owner and next action in athenaOne claim notes. (note 2)
- Follow up on unpaid claims by checking whether the payer received the claim and reviewing its processing status. Call payer representatives when needed. Record payer claim numbers, requested documents, filing or appeal deadlines, and follow-up dates under the practice's procedures.
- Compare electronic remittance advice with posted payments and adjustments in athenaOne. Investigate missing or unmatched items with the payment-posting team and refer unexpected patient balances to the billing lead before statements are released.
- Maintain an Excel follow-up log using filters and PivotTables to group open claims by payer, age, and unresolved reason. Bring recurring registration errors and outstanding coding requests to the weekly billing review.
- Verified insurance eligibility in payer portals and compared subscriber details with patient registration records. Updated confirmed information and sent coverage discrepancies to the billing specialist for review.
- Indexed payer correspondence and remittance documents to the matching accounts in the practice's billing system. Gathered missing claim references and routed unresolved items to the assigned biller.
Education
Skills
Medical billing, athenaOne, Claim corrections, Denial management, Claims follow-up, Remittance review, Insurance verification, Microsoft Excel
- Note 1:
The correction has a source: registration records and the payer response. Sending the claim again is not presented as proof of payment.
- Note 2:
Talia researches the issue and prepares a handoff. Coding decisions and appeal approval remain with the responsible staff.
Separate a corrected claim from a paid claim
Talia's first bullet names professional claims, which cover physician services, and the subscriber details she checks. It supports demographic and insurance-entry corrections. It does not establish that she assigns or changes diagnosis or procedure codes.
The follow-through matters: she tracks the corrected claim through submission and the next response. A claim sent successfully can still need more work. Writing “ensured reimbursement” would claim an outcome that this evidence does not demonstrate.
Experience
- Review rejected professional claims in athenaOne, compare subscriber details with registration records and payer responses, and correct verified demographic or insurance-entry errors. Track the corrected claim through submission and the next response.
- Follow up on unpaid claims by checking whether the payer received the claim and reviewing its processing status. Call payer representatives when needed. Record payer claim numbers, requested documents, filing or appeal deadlines, and follow-up dates under the practice's procedures. (note 1)
- Note 1:
Payer claim numbers, requested documents, deadlines, and a follow-up date make the next step visible to another biller.
Describe the claim types and exceptions you handled. Physician billing, hospital facility billing, dental billing, and workers' compensation can require different experience. Talia's sample does not demonstrate all of them. Use your employer's actual title and identify the setting in the summary or bullets.
A rejection during claim submission and a denial after payer processing need different follow-up. In a resume, name the response you worked from and your action rather than describing every unpaid item as a denial. The example does not imply that one correction or appeal method applies to every payer.
Show what your denial research handed off
“Resolved denials” leaves the reader guessing about the problem and your authority. Talia reviews the denial reason on the remittance, the claim history, and payer information, then separates coding questions from proposed appeals. Her notes identify who owns the next step.
This supports “Denial management” within the scope described. It does not show independent medical-necessity review, coding audits, appeal approval, or a successful appeal outcome. If you performed one of those tasks, describe your actual responsibility and evidence. If you gathered records for someone else, keep that handoff visible.
Experience
- Research denied claims using denial reasons on remittances, claim history, and payer portals. Send coding questions to the coding team and proposed appeals with supporting correspondence to the billing lead, recording the owner and next action in athenaOne claim notes.
- Compare electronic remittance advice with posted payments and adjustments in athenaOne. Investigate missing or unmatched items with the payment-posting team and refer unexpected patient balances to the billing lead before statements are released. (note 1)
- Note 1:
Checking posted transactions is different from posting the payments herself. An unexpected patient balance goes for review before a statement is released.
An electronic remittance advice records the payer's processing decision, payment, and adjustments. Talia compares it with the practice's posted payments and adjustments. A payment amount alone would leave the adjustment reasons and remaining balance unexplained. Her resume names the comparison and the exception handoff without claiming she sets patient liability or approves write-offs.
Use record types rather than patient identifiers or confidential account details in a public resume. A documented claim status, a verified correction, or a clear coding request can demonstrate useful work without a collection percentage. Add recovery amounts or denial-rate changes only when you can explain the calculation, period, and your contribution. The bullet-point guide offers other ways to show evidence without invented results.
Give software and reporting skills a clear scope
Talia uses athenaOne for claim worklists, notes, and remittance comparisons. That supports the system name in her skills list. It does not show implementation, system administration, or experience with another billing platform. Use the software you actually used and name the work it supported.
Her Excel log groups open claims by payer, age, and unresolved reason. Filters and PivotTables back up that reporting work. Bringing recurring registration errors and outstanding coding requests to the weekly review shows how she used the log. It does not suggest that the spreadsheet itself reduced denials.
All eight skills have evidence in the same resume. Insurance verification comes from her earlier Billing Assistant job, where she checked eligibility and recorded discrepancies. That job title and its dates remain intact. The earlier role does not become independent claim resolution because she later became a billing specialist.
If your experience centers on registration, appointments, and copays, compare the medical receptionist example. The accounts receivable specialist example covers commercial invoices and customer payments. Neither setting automatically establishes medical claim follow-up or coding expertise.
Match the opening and name credentials accurately
Read the posting for claim type, payer mix, systems, education, experience, and required or preferred credentials. A role centered on payment posting needs evidence that Talia's comparison work does not supply. A role requiring independent appeals, inpatient coding, or staff supervision also asks for experience outside this sample.
If a posting lists payer types such as Medicare, Medicaid, or commercial plans, name the ones you actually worked with. A request for an understanding of ICD-10 and CPT codes is not the same as a coding role. Show how you used that knowledge, such as recognizing when a denial needs the coding team, rather than claiming coding work.
For a claim-correction role, she could keep subscriber checks and submission tracking prominent. For a payer-follow-up role, claim status, correspondence, deadlines, and documented next actions deserve more space. Change the emphasis while preserving the actual responsibilities and dates.
Talia completed a school certificate in Medical Office Administration in June 2021. She has no professional certification. A training certificate and AAPC's Certified Professional Biller (CPB) credential are different qualifications. List CPB only if you hold it, with accurate issuer, dates, and status. Do not turn course completion or exam preparation into certification. The certifications guide shows how to label each clearly.
If you are entering billing, use your own administrative work and label classroom claim exercises as course projects using practice records. Do not present an exercise as responsibility for real patient accounts. Keep billing knowledge distinct from demonstrated coding work, and leave qualifications you have not earned out of the resume.