Medical Biller

About this position At Vancouver Sleep Center, we know how stressful it can be when sleep feels out of reach. That’s why we’ve built our practice around experience, accessibility, and patient-focused care. Our board-certified sleep specialists have decades of experience helping people improve their sleep and feel better in their daily lives. We guide you every step of the way, from detailed sleep consultations and in-depth studies to personalized treatment plans and medical equipment. As one of the sleep centers Portland, OR and the surrounding areas have relied on for decades, we understand how urgent sleep problems can be, so we strive to see new patients within a week of their first call. Position Summary The Medical Biller is responsible for ensuring the financial viability of the center by managing the full revenue cycle. This role requires a specialist who can navigate the unique coding requirements of polysomnography (PSG) and Home Sleep Apnea Testing (HSAT), ensuring that the 260+ monthly referrals are successfully billed, adjudicated, and collected. Detailed Essential Functions 1. Claims Coding & Submission Sleep-Specific Coding: Accurately apply CPT codes (e.g., 95810, 95811, 95800, 95806) and appropriate modifiers (TC, 26, or 52) based on the service provided. ICD-10 Proficiency: Ensure primary diagnoses (like G47.33 for OSA) are supported by the technician’s findings and physician’s interpretation. Electronic Batching: Clean and submit electronic claims via the clearinghouse, maintaining a low "Clean Claim Rate" (CCR) of 95% or higher. 2. Payer-Specific Navigation Governmental Billing: Manage Medicare Part B claims and ensure compliance with Local Coverage Determinations (LCDs). Military Payers: Handle the unique "Authorization to Claim" matching required for TriWest (VA CCN) and TRICARE West. Commercial PPO/HMO: Resolve "Medical Necessity" denials by coordinating with the Referral Coordinator to provide retro-authorizations or clinical notes. 3. Accounts Receivable (A/R) & Appeals Denial Management: Identify patterns in denials and execute formal appeals (Level 1 and Level 2) with clinical evidence. Patient Statements: Generate monthly statements and handle patient inquiries regarding high-deductible plans or co‑insurance for sleep studies. Payment Posting: Accurately post ERAs (Electronic Remittance Advice) and manual checks, reconciling bank deposits with EMR reports. Technical Competencies Area Responsibility Credentialing Assist in maintaining provider enrollment with Medicare and commercial panels. Audit Compliance Ensure all "Direct Sleep Study" referrals have a signed order and documented face‑to‑face visit to prevent "clawbacks". Financial Reporting Provide weekly "Aging Reports" (30, 60, 90+ days) to management. Qualifications Experience: 3+ years in medical billing; Sleep Medicine or DME (Durable Medical Equipment) experience is strongly preferred. Certification: CPB (Certified Professional Biller) or CPC (Certified Professional Coder) preferred. Software: Proficiency with medical billing software (Athena) and clearinghouses. Knowledge: Deep understanding of the No Surprises Act and Washington state-specific billing regulations. Days in A/R: Target Denial Rate: Success Metrics (KPIs) Days in A/R: Target Clean Claim Rate: > 95%. Denial Rate: About Vancouver Sleep Center At Vancouver Sleep Center, we know how stressful it can be when sleep feels out of reach. That’s why we’ve built our practice around experience, accessibility, and patient-focused care. Our board-certified sleep specialists have decades of experience helping people improve their sleep and feel better in their daily lives. We guide you every step of the way, from detailed sleep consultations and in-depth studies to personalized treatment plans and medical equipment. As one of the sleep centers Portland, OR and the surrounding areas have relied on for decades, we understand how urgent sleep problems can be, so we strive to see new patients within a week of their first call. Position Summary The Medical Biller is responsible for ensuring the financial viability of the center by managing the full revenue cycle. This role requires a specialist who can navigate the unique coding requirements of polysomnography (PSG) and Home Sleep Apnea Testing (HSAT), ensuring that the 260+ monthly referrals are successfully billed, adjudicated, and collected. Detailed Essential Functions 1. Claims Coding & Submission Sleep-Specific Coding: Accurately apply CPT codes (e.g., 95810, 95811, 95800, 95806) and appropriate modifiers (TC, 26, or 52) based on the service provided. ICD-10 Proficiency: Ensure primary diagnoses (like G47.33 for OSA) are supported by the technician’s findings and physician’s interpretation. Electronic Batching: Clean and submit electronic claims via the clearinghouse, maintaining a low "Clean Claim Rate" (CCR) of 95% or higher. 2. Payer-Specific Navigation Governmental Billing: Manage Medicare Part B claims and ensure compliance with Local Coverage Determinations (LCDs). Military Payers: Handle the unique "Authorization to Claim" matching required for TriWest (VA CCN) and TRICARE West. Commercial PPO/HMO: Resolve "Medical Necessity" denials by coordinating with the Referral Coordinator to provide retro-authorizations or clinical notes. 3. Accounts Receivable (A/R) & Appeals Denial Management: Identify patterns in denials and execute formal appeals (Level 1 and Level 2) with clinical evidence. Patient Statements: Generate monthly statements and handle patient inquiries regarding high-deductible plans or co‑insurance for sleep studies. Payment Posting: Accurately post ERAs (Electronic Remittance Advice) and manual checks, reconciling bank deposits with EMR reports. Technical Competencies Area #J-18808-Ljbffr