Medical Biller

Medical BillerThe Medical Biller supports the full revenue cycle by preparing and submitting accurate claims, reviewing coding and payer requirements, posting and reconciling payments, resolving denials and outstanding accounts, and assisting patients with billing questions. Team members may be assigned primary areas of responsibility based on departmental needs, experience, and training while providing cross-coverage for other billing functions.Core Behavioral ValuesCLEAR ID: Collaborate, Learn, Empathy, Accountable, Respect, Integrity, DedicationThese behaviors are based on Eyesight's culture and values critical to support the organizations mission of providing uncompromising care to patients.Essential FunctionsReview and validate claims for accurate patient, insurance, diagnosis, procedure, modifier, and other required informationPrepare, correct, and submit clean claims to insurance companies in accordance with payer and organizational requirementsApply knowledge of CPT, ICD-10, HCPCS, ophthalmology-specific coding, and applicable state and federal guidelinesResearch and resolve claim rejections, denials, underpayments, unpaid claims, and other accounts receivable issuesPrepare and submit appeals with the documentation needed to support timely and accurate reimbursementPost and reconcile patient and insurance payments, including checks, electronic fund transfers, credit card transactions, and explanation of benefitsProcess appropriate adjustments, credits, refunds, and corrections while maintaining accurate financial recordsRespond professionally to patient calls, messages, and questions regarding balances, insurance processing, financial obligations, and payment optionsCollect patient payments and assist with payment plans in accordance with organizational policiesUpdate patient, guarantor, and insurance information when discrepancies or changes are identifiedManage assigned billing communications, tasks, faxes, referrals, payer requests, and supporting documentationAssist with specialized billing functions such as Veterans Affairs, workers' compensation, surgical billing, end-of-day reconciliation, fee schedules, and financial reporting as assignedSupport prior authorization and insurance-verification functions within the scope of the employee's training and assigned responsibilitiesIdentify opportunities to improve billing accuracy, efficiency, compliance, and overall revenue cycle performanceMaintain organized documentation and comply with internal SOPs, HIPAA requirements, payer guidelines, and organizational policiesProvide cross-coverage and assist with other revenue cycle responsibilities as neededQualificationsHigh school diploma or GED requiredExperience in medical billing, coding, accounts receivable, payment posting, or a related healthcare setting preferredWorking knowledge of medical terminology, insurance guidelines, and claim-processing requirementsStrong analytical, problem-solving, organizational, and time-management skillsExcellent written and verbal communication skillsAbility to work independently while collaborating effectively with patients, providers, payers, and internal teamsPreferredMedical billing or coding certificationOphthalmology billing and coding experienceProficiency in EMR/PM systems (experience with ModMed a plus)Knowledge of Medicare, Medicaid, commercial insurance, HIPAA, and patient privacy standardsWork ConditionsProfessional healthcare setting, including clinics, administrative areas, and patient-facing environmentsNoise level ranges from quiet to moderate, depending on location and activityPotential exposure to infectious diseases, bodily fluids, or cleaning agents in accordance with standard protocolsPhysical RequirementsAbility to sit, stand, and walk for extended periodsFrequent use of hands and fingers to operate medical or office equipmentEffective verbal and written communication; ability to hear and understand speech in person and by phoneClose vision required for reading small print and viewing computer screensOccasional lifting or moving of objects up to 25 poundsMay involve reaching, bending, stooping, kneeling, or other physical movementAbility to manage multiple priorities and maintain professional interactions in a dynamic setting