Medical Biller

We are seeking a detail-oriented Medical Biller to join our team. The Medical Biller is responsible for preparing, submitting, and following up on insurance claims to ensure timely and accurate reimbursement. This position works with Medicare, Medicaid, Managed Care/HMO plans, commercial insurance carriers, and private pay accounts while maintaining compliance with all federal, state, and payer regulations.

Essential Duties & Responsibilities

• Prepare, review, and submit electronic and paper claims to Medicare, Medicaid, HMOs, commercial insurance carriers, and other third-party payers.
• Verify patient insurance eligibility and benefits.
• Ensure claims are coded accurately and meet payer billing requirements.
• Monitor claim status and resolve denials, rejections, and unpaid claims.
• Appeal denied claims and submit corrected claims when appropriate.
• Post insurance payments, adjustments, and patient payments accurately.
• Reconcile accounts and identify billing discrepancies.
• Communicate with insurance companies regarding claim status, authorizations, and payment issues.
• Respond to patient billing inquiries professionally and courteously.
• Maintain accurate documentation within the billing system and patient accounts.
• Stay current on Medicare, Medicaid, HMO, and commercial insurance billing guidelines and regulatory changes.
• Work collaboratively with clinical staff, admissions, and finance departments to resolve billing issues.
• Maintain confidentiality and comply with HIPAA regulations.

Qualifications

• High school diploma or GED required; Associate degree in Healthcare Administration, Medical Billing, or a related field preferred.
• Minimum of 1-2 years of medical billing experience preferred.
• Experience billing Medicare, Medicaid, Managed Care/HMO, and commercial insurance plans required.
• Long-term care or skilled nursing facility billing experience preferred.
• Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding is a plus.
• Strong understanding of insurance reimbursement processes and payer guidelines.
• Proficiency with electronic health records (EHR) and medical billing software.
• Proficient in Microsoft Office, particularly Excel.
• Excellent organizational, problem-solving, and communication skills.
• Ability to prioritize tasks and meet deadlines in a fast-paced environment.

Knowledge, Skills & Abilities

• Strong attention to detail and accuracy.
• Excellent analytical and critical thinking skills.
• Ability to work independently and as part of a team.
• Strong customer service and communication skills.
• Ability to maintain confidentiality and professionalism at all times.

Physical Requirements

• Prolonged periods of sitting and computer use.
• Occasional standing, walking, bending, and lifting up to 20 pounds.
• Ability to perform repetitive hand and wrist movements while using office equipment.

We are an Equal Opportunity Employer.