Medical Biller

Medical Biller

Reporting to the Revenue Cycle Manager, the Medical Biller will be responsible for the accurate and timely posting of insurance and patient payments, reconciliation of remittances, and aggressive follow-up of outstanding insurance balances. The ideal candidate will possess extensive experience with Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) posting, insurance denial management, and payer-specific reimbursement methodologies.

This position requires a strong working knowledge of UnitedHealthcare, Aetna, Horizon Blue Cross Blue Shield, Medicare, and other commercial payers, with demonstrated success in filing reconsiderations, appeals, and overturning claim denials. Prior experience in a surgical practice environment is required, with vascular surgery experience strongly preferred.

Essential Responsibilities

• Accurately post insurance and patient payments from EOBs, ERAs, EFTs, lockbox files, credit cards, cash, and paper checks.
• Review and reconcile remittance advice to ensure payments, adjustments, contractual allowances, deductibles, coinsurance, and patient responsibilities are correctly applied.
• Identify and research underpayments, overpayments, payment variances, and reimbursement discrepancies.
• Balance daily payment posting batches and ensure all deposits reconcile to bank deposits and practice management system records.
• Maintain complete and accurate documentation of all payment transactions and supporting remittance records.

Insurance Accounts Receivable Management

• Manage assigned insurance A/R work queues to ensure timely follow-up and resolution of outstanding claims.
• Analyze unpaid, partially paid, and denied claims to determine root cause and appropriate corrective action.
• Conduct payer follow-up via payer portals, telephone, and written correspondence.
• Monitor aging reports and prioritize accounts to maximize collections and reduce days in A/R.
• Escalate complex reimbursement issues and payer trends to Billing Management.

Denials, Reconsiderations & Appeals

• Review denial codes, payer policies, medical necessity determinations, bundling edits, authorization issues, and coding-related denials.
• Prepare and submit reconsiderations, corrected claims, and formal appeals with supporting documentation.
• Demonstrate strong knowledge of UnitedHealthcare, Aetna, Horizon BCBS, Medicare, and other commercial payer reimbursement policies and appeal processes.
• Work collaboratively with providers, coding staff, and management to obtain documentation necessary to support successful appeal outcomes.
• Track appeal status and ensure timely follow-up through final resolution.

Surgical Billing Support

• Understand surgical billing concepts including global surgical periods, modifiers, operative reports, authorizations, and payer-specific reimbursement guidelines.
• Review surgical claims for completeness and identify issues impacting reimbursement.
• Collaborate with coding and billing teams to ensure accurate claim submission and payment resolution.
• Support vascular laboratory, vascular surgery, and related specialty billing functions as needed.

Additional Responsibilities

• Maintain accurate electronic records and documentation within the practice management system.
• Respond professionally to inquiries from patients, providers, staff, and insurance representatives regarding billing and payment matters.
• Assist with special projects, reporting, and revenue cycle initiatives as assigned.
• Support the overall financial performance and collection efforts of the practice.

Required Qualifications

• Minimum 5 years of medical billing experience with a primary focus on insurance accounts receivable and payment posting.
• Minimum 3 years of surgical practice billing experience required; vascular surgery experience strongly preferred.
• Extensive experience posting EOBs, ERAs, EFTs, and manual payments.
• Proven success resolving insurance denials, underpayments, and aging accounts receivable.
• Strong working knowledge of UnitedHealthcare, Aetna, Horizon BCBS, Medicare, and commercial payer reimbursement methodologies.
• Experience preparing and submitting reconsiderations, corrected claims, and formal appeals.
• Thorough understanding of medical terminology, insurance billing practices, CPT, ICD-10, modifiers, and claim adjudication processes.
• Proficiency with electronic health record (EHR) and practice management systems.
• Strong analytical, organizational, and problem-solving skills.
• Exceptional attention to detail and commitment to accuracy.
• Ability to prioritize multiple responsibilities and meet established deadlines.
• Excellent written and verbal communication skills.

Preferred Qualifications

• Experience with vascular surgery, general surgery, or other surgical specialties.
• Familiarity with payer portals and electronic claims management systems.
• Knowledge of Medicare Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and commercial payer medical policies.
• Revenue cycle management and denial prevention experience.

Education

• High School Diploma or equivalent required.
• Associate's or Bachelor's degree in Healthcare Administration, Business, or related field preferred.
• Medical Billing or Coding certification is a plus.

The Cardiovascular Care Group