Medical Biller

Job Description

Job Description

Key Responsibilities

Authorization Management

• Obtain and verify prior authorizations for services, treatments, and procedures.
  
• Review patient insurance eligibility and benefits to ensure coverage requirements are met.
  
• Submit authorization requests accurately and timely through payer portals, fax, or phone.
  
• Track authorization status and follow up with insurance companies as needed.
  
• Maintain accurate documentation of authorization approvals, denials, and expiration dates.
  
• Communicate authorization updates to clinical and scheduling teams.
  

Denial Management

• Review denied or rejected claims to identify root causes and trends.
  
• Research payer policies and determine appropriate corrective actions.
  
• Prepare and submit appeals with supporting documentation within payer deadlines.
  
• Work collaboratively with billing, coding, and clinical departments to resolve claim issues.
  
• Monitor denial reports and maintain denial logs for tracking and reporting purposes.
  
• Escalate unresolved or recurring denial issues to leadership.
  

Revenue Cycle Support

• Assist with claim edits, payment posting discrepancies, and reimbursement follow-up.
  
• Ensure compliance with payer guidelines, CMS regulations, and company policies.
  
• Support process improvement initiatives aimed at reducing denials and increasing collections.
  
• Maintain confidentiality of patient and financial information in accordance with HIPAA regulations.
  
• Participate in audits, training, and departmental meetings as required.
  
• Fosters a culture of customer service and commitment to quality care
  
• Shows a genuine interest and compassion for the communities we serve and commitment to the diversity of our clients and team members
  
• Mentor and supports team members
  
• Complete other tasks as assigned
  

What we are looking for:

• High school diploma or equivalent required; Associate’s degree preferred.
  
• Minimum of 2 years of experience in healthcare revenue cycle, medical billing, authorizations, or denial management.