Medical Biller

Job Description Job Description Job Summary Medical Biller The Medical Biller reports to the Billing Manager in person at out office in Ontario, CA and is responsible for the accurate, compliant, and timely billing of clinical laboratory services, includingblood testing, microbiology/culture testing, and toxicology services. This role requires strong expertise inMedicare Part A vs Part B billing, skilled nursing facility (SNF) workflows, and commercial payer laboratory billing rules. The Medical Biller manages claims from Pending Review through payment resolution while ensuring full compliance withMedicare, Medicaid, and commercial payor regulations. No Remote Work Available Supervisory Responsibilities None Essential Duties and Responsibilities Laboratory Billing & Claims Management Review laboratory patient demographics, insurance, ordering provider, and facility information. Prepare, review, and submit insurance claims for laboratory services provided by Brio Clinical Partners, including blood testing, microbiology/culture, and toxicology. Accurately apply CPT, HCPCS, and ICD-10 codes in accordance with payer and regulatory guidelines. Distinguish and bill correctly underMedicare Part A vs Medicare Part B, Medicare Advantage, Medicaid, and commercial insurance plans. Coding, Medical Necessity & Compliance Review claims for medical necessity in compliance withMedicare LCDs/NCDsand commercial payer policies. Ensure proper toxicology billing, including correct differentiation betweenscreening vs confirmatory testing, frequency limits, and unit reporting. Identify and resolve coding, diagnosis, or documentation issues prior to claim submission. Maintain strict adherence to Brio Clinical Partners' compliance policies and HIPAA regulations. Insurance Verification & Authorization Verify insurance eligibility and benefits prior to billing when required. Identify payer authorization or referral requirements for laboratory services. Confirm Brio's in-network or out-of-network status and apply correct billing methodology. Payment Posting & Reconciliation Accurately post payments, contractual adjustments, denials, and refunds from EOBs and ERAs. Reconcile payments against Brio's expected reimbursement schedules and contracted rates. Identify under payments, overpayments, and payer processing errors and elevate to management as appropriate. Denials Management & Appeals Research and resolve claim denials related to: Medicare Part A vs Part B determinations Medical necessity Coverage or authorization issues Coding or billing errors Prepare and submit appeals with supporting clinical and billing documentation. Track appeal outcomes and identify trends to reduce future denials. SNF & Client Billing Support Collaborate with skilled nursing facilities and internal teams regarding census reports, patient status, and billing responsibility. Generate and manage client invoices forfacility-responsibility or non-covered services. Communicate billing outcomes clearly and professionally with SNF partners and internal stakeholders. Reporting & Productivity Maintain accurate billing logs, work queues, and documentation. Meet Brio Clinical Partners' productivity, accuracy, and turnaround time standards. Prepare billing, payment, and denial reports for leadership review. Quality Assurance & Process Improvement Identify recurring billing issues and recommend workflow improvements. Stay current on changes to laboratory billing regulations, Medicare policies, and payer requirements relevant to Brio’s testing services. Billing Claims Submit clean and accurate insurance claims (electronic and paper) in compliance with payer and regulatory guidelines Review claims for completeness, coding accuracy, and required documentation prior to submission Ensure timely filing limits are met for all payers Maintain accurate claim notes and follow-up logs EOB Review / Negotiations / Claim Tracing Analyze Explanation of Benefits (EOBs) for accuracy of payments, adjustments, and denials Identify underpayments, incorrect contractual adjustments, and non-covered charges Identify claims eligible for negotiation and report them to the supervisor for review E #J-18808-Ljbffr