Medical Biller/Collector

Job Summary This position will perform collections and medical billing for various regional and national payers, including Federal, State, Third Party (HMO, PPO, IPA, TPA Indemnity) and patient billing. Qualified candidates must review accounts for billing accuracy to maximize reimbursement, pursue tenacious follow‑up on claim status, appeal, re‑bill or forward claims for recalculation, and possess detailed knowledge of all medical benefit levels and federal, state, PPO, HMO and indemnity plan structures. Candidates must meet or exceed performance standards on assigned accounts. Essential Responsibilities Data entry and correct insurance assignment to patient accounts, verify insurance eligibility, and review/update demographics and patient information for accuracy. Apply appropriate coding systems (CPT, ICD‑9, HCPCS, coverage, LCD/NCD) and understand reimbursement associated with such codes. Process, validate payer requests and processed claims via correspondence, remittance advice and EOBs, identifying payment discrepancies and inappropriate requests. Investigate denied services to determine denial reasons, file appeals when appropriate, and report root causes of denials. Process appeals timely, develop, submit, track, report and evaluate appeal outcomes. Maximize use of billing system, tools and resources to support cash‑collection activities. Review aging, adjustments and credit balance reports. Comply with federal and state legislation, safety, emergency, OSHA, HIPAA, quality assurance and administrative plans, policies, guidelines, protocols and standards. Support and maintain department cash and DSO goals. Other duties as assigned. Requirements High School Diploma and a minimum of four years related experience, or Bachelor’s degree (or combination of education and experience). Working knowledge and hands‑on experience of medical billing and reimbursement. Proficiency with Microsoft Outlook, Excel, Word and related business applications. Strong problem‑solving skills, good judgment, attention to detail and follow‑through. Excellent customer service, verbal and written communication skills. Ability to prioritize, multi‑task, manage time and work independently. Adaptability to increased business demands and complex billing issues. Team‑work orientation and supportive collaboration with colleagues. Seniority Level Entry level Employment Type Full‑time Job Function Health Care Provider #J-18808-Ljbffr PreludeDx