A Medical Biller is responsible for processing and submitting claims to insurance companies to ensure healthcare providers receive proper reimbursement for services rendered, playing a critical role in maintaining the financial health and operational efficiency of medical practices by minimizing claim denials and optimizing revenue cycles.
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What is a Medical Biller?
A Medical Biller is a healthcare administrative professional who specializes in the financial aspect of medical services. They act as a crucial link between healthcare providers, patients, and insurance companies, ensuring that medical claims are accurately processed and payments are received in a timely manner. Their expertise in medical coding, insurance guidelines, and billing software makes them essential to the revenue cycle management of any medical facility.
What does a Medical Biller do?
Medical Billers perform a variety of tasks to manage the billing process efficiently. They review patient records and treatment documentation to assign appropriate medical codes using standardized systems like ICD-10, CPT, and HCPCS. They prepare and submit claims to insurance companies electronically or by mail, following up on unpaid or denied claims to resolve discrepancies and secure payments. Additionally, they handle patient billing inquiries, set up payment plans, and maintain accurate financial records to ensure compliance with healthcare regulations and optimize revenue collection for the practice.
Job Overview
We are seeking a detail-oriented Medical Biller to manage our healthcare billing operations. The ideal candidate will be responsible for processing insurance claims, verifying patient information, and ensuring accurate reimbursement for medical services provided. This role requires strong knowledge of US healthcare billing systems, insurance protocols, and regulatory compliance standards.
Medical Biller responsibilities include:
1. Submit and track insurance claims using ICD-10, CPT, and HCPCS coding systems
2. Verify patient insurance coverage and benefits eligibility
3. Process electronic and paper claims through clearinghouses like Change Healthcare
4. Follow up on unpaid claims and manage accounts receivable
5. Handle patient billing inquiries and payment arrangements
6. Review and appeal denied claims with supporting documentation
7. Maintain compliance with HIPAA regulations and payer requirements
8. Reconcile daily billing activities and generate financial reports
1. 2+ years of medical billing experience in US healthcare setting
2. Proficiency with medical billing software (e.g., Epic, Cerner, NextGen)
3. Thorough knowledge of ICD-10, CPT, and HCPCS coding systems
4. Understanding of HIPAA compliance and patient privacy regulations
5. Experience with insurance verification and claims submission processes
6. High school diploma or equivalent required
Preferred Qualifications
1. Certified Professional Biller (CPB) or Certified Medical Reimbursement Specialist (CMRS) certification
2. Associate's degree in Healthcare Administration or related field
3. Experience with Medicare/Medicaid billing requirements
4. Knowledge of EHR systems and patient scheduling software
5. Previous experience in specialty practice billing (e.g., oncology, cardiology)
Bonus Skills
1. Bilingual skills (Spanish/English)
2. Experience with revenue cycle management
3. Knowledge of value-based care billing models
4. Familiarity with medical coding auditing processes
5. Advanced Excel skills for financial reporting and analysis
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