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Billing Adjudicator Jobs (NOW HIRING)

Quality Life Services

Billing Associate

Chicora, PA

$17.75 - $22.25/hr

Adjudication of pharmacy claims with third party payers. * Contact third party payers for over ... Billing and organizing of Emergency kits. REQUIREMENTS: * Prior medical/pharmacy billing experience

Posted today

Quality Life Services

Billing Associate

Chicora, PA · On-site

$17.75 - $22.25/hr

Adjudication of pharmacy claims with third party payers. * Contact third party payers for over ... Billing and organizing of Emergency kits. REQUIREMENTS: * Prior medical/pharmacy billing experience

Posted today

Coral Connect LLC

Billing Specialist

Boca Raton, FL · On-site +1

$18.25 - $24.75/hr

Billing Specialist Company Bio: Coral Connect, LLC ("Coral") is a technology-enabled service ... Review claim adjudication responses and identify claim issues. * Resolve claim rejections and payer ...

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How much do billing adjudicator jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for billing adjudicator in the United States is $20.79, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $21.88 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a billing adjudicator, and why are they important?

To thrive as a Billing Adjudicator, you need strong analytical skills, attention to detail, and knowledge of medical billing and insurance claims processes, often supported by an associate degree or relevant certification. Familiarity with claims management software, electronic health record (EHR) systems, and coding standards like ICD-10 and CPT is typically required. Excellent communication, problem-solving abilities, and organizational skills help address discrepancies and interact effectively with providers and insurers. These competencies ensure accurate claims processing, reduce errors, and facilitate timely reimbursement within healthcare or insurance organizations.

What skills are needed for claim adjudication?

Billing Adjudicators need strong attention to detail, analytical skills, and knowledge of insurance policies and billing procedures. Proficiency with claims processing software and good communication skills are also important for reviewing and resolving claims efficiently.

What is a billing adjudicator?

Billing Adjudicators are professionals responsible for reviewing, evaluating, and processing insurance claims or billing disputes in healthcare, insurance, or related fields. They analyze submitted claims for accuracy, verify eligibility, ensure compliance with relevant policies, and determine the appropriate payment or denial. Their role helps ensure that payments are made correctly and in accordance with regulations and contractual agreements. Billing Adjudicators often work closely with healthcare providers, insurance companies, and patients to resolve billing issues.

What are some common challenges a billing adjudicator faces when reviewing and processing claims?

A Billing Adjudicator often encounters challenges such as interpreting complex insurance policies, identifying discrepancies in claims data, and ensuring compliance with ever-changing regulations. Staying updated on the latest payer guidelines and efficiently handling large volumes of claims while maintaining accuracy can also be demanding. Collaboration with other departments, such as coding and compliance teams, is essential to resolve claim discrepancies and improve workflow. Strong attention to detail and effective communication skills are key to overcoming these challenges.

What is the difference between Billing Adjudicator vs Claims Processor?

AspectBilling AdjudicatorClaims Processor
CredentialsTypically requires insurance or healthcare billing certificationsOften requires similar certifications, such as medical billing or claims processing
Work EnvironmentHealthcare or insurance companies, hospitals, or clinicsInsurance companies, healthcare providers, or third-party claims organizations
Job FocusReviewing and validating billing claims for accuracy and complianceProcessing and adjudicating insurance claims for payment

The main difference between a Billing Adjudicator and a Claims Processor lies in their focus: Billing Adjudicators primarily review and validate billing claims for accuracy, while Claims Processors handle the initial processing and adjudication of insurance claims. Both roles require similar certifications and are found in healthcare and insurance settings, but their specific responsibilities differ slightly.

More about Billing Adjudicator jobs
What job categories do people searching Billing Adjudicator jobs look for? The top searched job categories for Billing Adjudicator jobs are:
Billing Adjudicator jobs near you
Infographic showing various Billing Adjudicator job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 83% Full Time, 11% Part Time, and 4% Contract. Highlights an 90% Physical, 4% Hybrid, and 6% Remote job distribution, with an average salary of $43,233 per year, or $20.8 per hour.

Billing Specialist

Grandview Medical Center

Birmingham, AL

$18 - $24.25/hr

Full-time

Re-posted 9 days ago

Grandview Medical Center (Alabama) rating

5.7

Company rating: 5.7 out of 10

Based on 50 frontline employees who took The Breakroom Quiz

914th of 1,058 rated hospitals

Job description

Job Description Job Summary
The Billing Specialist II is responsible for managing complex billing functions, ensuring timely and accurate claims processing, and resolving issues related to insurance payments and account balances. This position serves as the primary contact for insurance companies and other payers, performing in-depth research to facilitate claim resolution and maximize collections. The Billing Specialist II also supports team training, assists with audits, and ensures compliance with payer regulations and company policies.
Essential Functions
  • Serves as the primary point of contact for insurance companies, payers, and patients regarding billing inquiries and claim resolution.
  • Reviews and processes insurance claims, ensuring timely submission and compliance with payer guidelines.
  • Identifies and resolves credit balances, reclassifies revenue, and processes adjustments according to transaction coding policies.
  • Reviews and corrects claim filing edits in electronic health record (EHR) and practice management systems (e.g., Athena, Cerner, Ingenious Med).
  • Researches and resolves claim denials and rejections, working proactively to identify trends and implement corrective actions.
  • Monitors and works vendor/payer audit trails, submitting secondary claims and addressing discrepancies as needed.
  • Maintains up-to-date knowledge of federal, state, and payer billing guidelines, utilizing payer websites for claims follow-up.
  • Assists in training staff and providers on billing updates, maintaining a centralized electronic repository for reference materials.
  • Ensures proper billing and collection procedures in collaboration with management, clinic staff, and coding teams.
  • Maintains confidentiality and ensures compliance with HIPAA regulations and company policies.
  • Performs other duties as assigned.
  • Maintains regular and reliable attendance.
  • Complies with all policies and standards.
Qualifications
  • 2-4 years of experience in medical billing, insurance claims processing, or revenue cycle management required
  • 1-3 years in collections, knowledge of third party billing, and insurance reimbursement required
  • 0-1 years of experience with Medicare preferred
Knowledge, Skills and Abilities
  • Advanced knowledge of medical billing processes, insurance claim procedures, and payer policies.
  • Strong understanding of revenue cycle management, including insurance reimbursement and claim adjudication.
  • Proficiency in electronic health records (EHR) and practice management systems.
  • Ability to analyze and resolve complex billing issues, including denials and payment discrepancies.
  • Strong communication and problem-solving skills to interact with patients, providers, and payers.
  • Ability to train and mentor team members on billing best practices.
  • Detail-oriented with the ability to meet deadlines and manage multiple priorities.
  • Working knowledge of HIPAA regulations and data confidentiality requirements.
Licenses and Certifications
  • CPB- Certified Medical Biller issued by AAPC preferred or
  • Certified Medical Insurance Specialist (CMIS) issued by PMI preferred

What Grandview Medical Center (Alabama) employees say

Pay

Benefits

Hours and flexibility

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About Grandview Medical Center

Sourced by ZipRecruiter

Grandview Medical Center is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and offers programs and services in all medical and surgical areas, including Cardiology, Oncology, Neurology, Women's Health, Mental Health, Digestive Diseases, Orthopedics, Physical Medicine and Rehab, Sports Medicine and Emergency Care. There are more than 600 physicians on the Grandview medical staff representing 30 specialties and subspecialties. The hospital has been named an accredited program for Metabolic and Bariatric surgery by ASMBS & ACS as well as an accredited chest pain center.

Industry

Hospitals

Company size

1,001 - 5,000 Employees

Headquarters location

Birmingham, AL, US

Year founded

2015

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