Medical Biller ( Junior )

Medical Biller (Junior)

Plutus Health Inc. is a leading provider of Revenue Cycle Management (RCM) services with SOC2 Certification. We are dedicated to helping healthcare providers improve their financial performance. Our expertise spans various healthcare specialties, and we are committed to delivering exceptional service and innovative solutions to our clients.

Plutus Health is seeking a Medical Biller (Junior) to support day-to-day medical billing and revenue cycle activities, with responsibility for assisting with Independent Dispute Resolution (IDR) and payer dispute workflows.

Key Responsibilities

• Perform day-to-day medical billing activities, including claim review, submission, and follow-up.
• Review claims for billing accuracy, payer requirements, and potential reimbursement issues.
• Work on claim corrections, rejected claims, denials, and underpayments.
• Perform AR follow-up through payer portals, phone calls, and other payer communication channels.
• Verify claim status, payment details, denial reasons, and payer responses.
• Identify billing and reimbursement discrepancies and take appropriate corrective action.
• Maintain accurate documentation and follow established billing and RCM workflows.

IDR & Payer Dispute Support (Training will be provided)

• Assist with Independent Dispute Resolution (IDR) cases and related payer dispute activities.
• Review disputed claims and supporting documentation to determine required next steps.
• Access and navigate payer and IDR portals to review case status, submit information, and track updates.
• Assist with gathering and organizing claim details, payment information, medical billing records, and supporting documentation for IDR submissions.
• Track IDR cases, deadlines, submissions, responses, and outcomes using internal trackers.
• Support appeals, payment disputes, and out-of-network reimbursement matters as assigned.
• Coordinate with AR, denial management, billing, and operational teams to obtain information required for dispute resolution.
• Escalate complex or high-priority cases to the appropriate leadership team.
• Stay informed about changes to IDR requirements, payer processes, and applicable reimbursement guidelines.

Documentation & Operations

• Maintain accurate case notes, trackers, reports, and documentation.
• Ensure timely completion of assigned billing and IDR activities.
• Follow company SOPs, HIPAA requirements, payer guidelines, and applicable regulatory requirements.
• Identify recurring billing or payer issues and communicate trends to leadership.
• Support process improvement initiatives related to medical billing, denials, AR, and IDR workflows.
• Collaborate effectively with onshore and offshore operational teams.

Required Qualifications

• 6 months 1 year of experience in medical billing, healthcare RCM, AR follow-up, claims processing, or denial management.
• Strong understanding with some hand on the medical billing and healthcare revenue cycle workflow.
• Some hands-on experience with claims, denials, AR follow-up, payment posting, payer portals, or reimbursement issues is preferred.
• Ability to review claims and understand payer responses, denial reasons, and reimbursement discrepancies.
• Experience working with commercial insurance payers and/or healthcare payer portals is preferred.
• Strong attention to detail and ability to manage multiple claims or cases simultaneously.
• Good verbal and written communication skills.
• Proficiency with Microsoft Excel and maintaining operational trackers.
• Ability to work onsite in Dallas, TX.

What We Offer

• Opportunity to work with a rapidly growing healthcare RCM organization.
• Hands-on exposure to medical billing, AR, denials, payer disputes, and IDR operations.
• Opportunity to develop specialized knowledge in healthcare reimbursement and dispute resolution.
• Collaborative and growth-focused work environment.
• Career advancement opportunities within RCM, AR, denial management, and operations.