Job Description
We are looking for a highly detailed, collaborative, and Bilingual Medical Biller - Referral and Eligibility Specialist to join our growing orthopedic billing department. This role focuses heavily on the front-end revenue cycle, serving as our primary defensive line against insurance denials by mastering insurance verification, eligibility auditing, and referral acquisition before the patient ever steps into the clinic. Operating across four busy office locations , your primary directive is to bridge the communication gap between all stakeholders in the patient's care. On any given day, you will act as a core liaison—collaborating in real-time with our internal front desk teams to resolve coverage discrepancies, communicating empathetically with patients to clarify complex insurance rules, and proactively contacting outside Primary Care Physician (PCP) clinics and insurance providers to secure required electronic referrals. To thrive in this role, you must possess a deep understanding of U.S. commercial and government payer structures, a relentless eye for detail, and the ability to maintain fluid, professional communication across high-volume networks. Key Responsibilities: Insurance Verification & Eligibility Auditing High-Volume Portfolio Management: Efficiently manage and own the end-to-end insurance verification workflow for two of our four busy office locations, splitting total practice volume evenly with a partner specialist. Proactive Discrepancy Auditing: Look beyond automated systems; manually audit and resolve complex eligibility discrepancies flags within the ModMed EMR 24 to 48 hours prior to patient arrival to preemptively catch front-end errors. Comprehensive Benefit Tracking: Meticulously audit and update patient accounts regarding critical financial metrics, including active/inactive insurance coverage, out-of-pocket maximums, copays, and remaining deductibles. Direct Insurance & Patient Outreach: Initiate direct contact with commercial and governme
