Medical Billing Representative

Description

Position Summary

The Medical Billing Representative plays a key role in the revenue cycle by monitoring claim status, researching and resolving claim rejections and denials, collecting outstanding balances, and assisting patients with billing-related inquiries. This individual works closely with providers, patients, insurance companies, and internal departments to ensure claims are processed accurately and payments are received in a timely manner.

Essential Duties and Responsibilites

• Monitor claim status and follow up on unpaid, rejected, or denied claims to ensure timely reimbursement.
• Maintain consistent phone availability and proactively make outbound calls to patients, payers, and other stakeholders.
• Collect outstanding patient balances and accurately post payments within the Electronic Health Record (EHR) system.
• Research, correct, and process claims for Medicare, Medicaid, commercial insurance plans, and other payer types.
• Verify claims are submitted correctly and resolve claim edits, denials, and payment discrepancies.
• Educate patients regarding account balances, payment options, and billing inquiries.
• Communicate with providers regarding incomplete or insufficient documentation needed for proper claim adjudication.
• Assist with daily deposit reconciliation and patient payment balancing.
• Support internal and external billing audits by gathering and preparing requested documentation.
• Process patient refund requests according to established policies and procedures.
• Collaborate with billing leadership to resolve complex account and reimbursement issues.
• Handle incoming patient billing calls in a professional, courteous, and timely manner.
• Review and respond to written correspondence related to patient accounts.
• Communicate effectively with patients, providers, insurance carriers, and team members through phone, email, and written communication.
• Identify denial trends, reimbursement concerns, and recurring patient account issues and communicate findings to leadership.
• Research account discrepancies, document findings thoroughly, and recommend resolution steps.
• Maintain current knowledge of payer guidelines, industry regulations, and billing best practices.
• Ensure compliance with HIPAA regulations and maintain strict patient confidentiality.
• Foster a positive, collaborative team environment focused on service excellence and departmental goals.
• Perform other duties as assigned.

Requirements

To perform this role successfully, an individual must be able to carry out each essential duty with a high degree of accuracy, professionalism, and customer service. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Education & Experience

• High school diploma or GED required.
• Two to four (2-4) years of medical billing, collections, revenue cycle, or related healthcare experience preferred.
• Experience working with Medicare, Medicaid, and commercial insurance plans preferred.
• Physician practice or specialty healthcare billing experience is a plus.

Knowledge, Skills & Abilities

• Strong verbal and written communication skills.
• Excellent customer service and patient relations skills.
• Working knowledge of medical billing workflows, payer requirements, claims processing, and reimbursement practices.
• Ability to research and resolve billing, denial, and collection issues effectively.
• Strong organizational, critical thinking, and problem-solving skills.
• Proficiency with Electronic Health Records (EHR), practice management systems, and Microsoft Office applications.
• Ability to maintain confidentiality and comply with HIPAA regulations.
• Bilingual skills are preferred.

Physical Demands

• Frequently sits, stands, and uses a computer for extended periods.
• Ability to communicate effectively in person, by phone, and electronically.
• May occasionally lift, carry, push, or pull up to 20-25 pounds.
• Ability to perform work in a fast-paced office environment while maintaining accuracy and attention to detail.

The physical demands described here are representative of those required to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

Work Environment

• Office Environment: Primarily performed in a professional office setting using standard office equipment, including computers, telephones, printers, and scanners.
• Travel: Less than 25% travel may be required for training, meetings, or business-related activities.

Why Join Carolina Digestive Health Associates?

At Carolina Digestive Health Associates, we are committed to providing exceptional patient care while fostering a supportive and collaborative workplace. We value our team members and offer opportunities for professional growth, development, and career advancement.

• Competitive compensation and benefits package
• Supportive and team-oriented culture
• Opportunities for professional development
• Stable and growing specialty healthcare organization
• Meaningful work that supports both patient care and organizational success

Carolina Digestive Health Associates is an Equal Opportunity Employer and is committed to creating an inclusive workplace for all employees.