Medical Biller

Medical Biller – Revenue Cycle Management (RCM)

Position Summary

The Medical Biller is responsible for the complete revenue cycle management (RCM) process, ensuring claims are accurately billed, followed through to payment, and resolved in a timely manner. This role requires strong knowledge of insurance billing, payment posting, accounts receivable management, and payer guidelines while maintaining high productivity and accuracy.

Key Responsibilities

• Review, scrub, and submit professional and facility claims accurately and timely.
• Process electronic and paper claims through clearinghouses and insurance carriers.
• Post insurance and patient payments accurately from ERAs, EOBs, EFTs, and manual payments.
• Manage Accounts Receivable (A/R) by following up on unpaid, underpaid, and denied claims.
• Research and resolve claim rejections, denials, and payment discrepancies.
• Prepare and submit corrected claims, reconsiderations, and appeals as needed.
• Work aging reports and claim work queues to ensure accounts are touched regularly and resolved promptly.
• Maintain familiarity with Medicare, Medicaid, Managed Medicaid, Commercial insurance, Workers' Compensation, and other payer requirements.
• Understand payer-specific billing rules, authorization requirements, timely filing limits, and reimbursement policies.
• Verify insurance eligibility and benefits when necessary.
• Review patient balances and ensure accurate patient billing.
• Identify billing trends and escalate recurring payer or workflow issues.
• Collaborate with coding, front desk, providers, and management to resolve billing issues affecting reimbursement.
• Ensure documentation supports claim submission and reimbursement requirements.
• Maintain accurate account notes and documentation for all billing activity.
• Meet departmental productivity, quality, and collection goals.
• Stay current on insurance regulations, billing requirements, and coding updates affecting reimbursement.
• Maintain HIPAA compliance and protect patient confidentiality at all times.
• Assist with special billing projects and other Revenue Cycle Management initiatives as assigned.

Qualifications

• 1+ years of medical billing experience preferred.
• Strong understanding of Revenue Cycle Management (RCM).
• Experience with payment posting, insurance follow-up, and accounts receivable.
• Familiarity with Medicare, Medicaid, and commercial insurance carriers.
• Experience working within an Electronic Medical Record (EMR) and Practice Management system.
• Strong analytical, organizational, and problem-solving skills.
• Ability to manage multiple priorities while maintaining accuracy and productivity.
• Excellent communication and teamwork skills.