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.
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.
Post payments (insurance and patient) accurately into the system.
Reconcile payments against claims and identify discrepancies.
Process adjustments, write-offs, and refunds where necessary.
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.
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.
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.
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.
Bachelor’s degree in Healthcare Administration, Business, Finance, or related field (preferred).
Minimum of 3 years of experience in medical billing or revenue cycle management.
Experience working with U.S. healthcare systems and insurance payers is required.
Proficiency in medical billing software (e.g., Kareo, AdvancedMD, Athenahealth, eClinicalWorks).
Strong knowledge of CPT, ICD-10, and HCPCS coding systems.
Advanced skills in Microsoft Excel and Google Workspace.
Experience with clearinghouses and EHR/EMR systems.
Attention to Detail: High accuracy in claim preparation and data entry.
Analytical Skills: Ability to identify trends in denials and billing issues.
Communication: Strong written and verbal English skills for payer and patient interactions.
Organization: Ability to manage multiple claims, deadlines, and follow-ups efficiently.
Problem Solving: Proactive in resolving billing discrepancies and reducing revenue loss.
Stable internet connection (for remote roles).
Ability to work within U.S. business hours (if required).
Quiet and professional work environment.
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