Job Description
Job Overview The Medical Biller is responsible for managing the end-to-end medical billing process, ensuring accurate claim submission, timely reimbursements, and compliance with U.S. healthcare billing regulations. This role involves working closely with healthcare providers, insurance companies, and internal teams to resolve billing issues, reduce claim denials, and optimize revenue cycle performance. Key Responsibilities 1. Claims Processing & Submission Prepare, review, and submit accurate medical claims (electronic and paper) to insurance companies. Ensure proper coding (CPT, ICD-10, HCPCS) and billing compliance before submission. Verify patient insurance eligibility and benefits prior to billing. 2. Payment Posting & Reconciliation Post payments (insurance and patient) accurately into the system. Reconcile payments against claims and identify discrepancies. Process adjustments, write-offs, and refunds where necessary. 3. Denials & Follow-Ups Monitor unpaid claims and follow up with insurance companies for resolution. Investigate denied or rejected claims and initiate appeals where applicable. Maintain a structured follow-up process to ensure timely reimbursement. 4. Accounts Receivable (AR) Management Track and manage aging reports to reduce outstanding balances. Prioritize high-value and aging claims for follow-up. Collaborate with internal teams to resolve billing issues impacting collections. 5. Compliance & Documentation Ensure all billing activities comply with HIPAA and payer-specific guidelines. Maintain accurate and up-to-date billing records and patient information. Support audits by providing required billing documentation promptly. 6. Reporting & Communication Generate regular billing and AR reports for internal review. Communicate with patients regarding billing inquiries when necessary. Collaborate with providers, coders, and administrative teams to resolve discrepancies. Education & Experience Bachelor’s degree in Healthcare Administration, Busi
