Medical Biller

Medical Biller Job Description

DEPARTMENT

Revenue Cycle Management / Billing

DESCRIPTION

We are hiring a Medical Biller to manage the insurance billing and revenue cycle process for a specialty mental health and pain medicine practice. The ideal candidate will have hands-on experience with U.S. medical billing, insurance claims, payer portals, eligibility, prior authorizations, claim follow-up, and denial resolution.

The Medical Biller will be responsible for ensuring claims are accurately prepared and submitted, monitored through the payer process, and followed through to payment or resolution. The role will work closely with the practice's billing, AR, administrative, and clinical teams to maintain a clean and efficient revenue cycle.

KEY RESPONSIBILITIES

- Insurance Billing & Claims.

- Prepare and submit accurate CMS-1500 professional claims to commercial, Medicare, Medicare Advantage, and Medicaid payers.

- Review patient and insurance information before claim submission to ensure accuracy.

- Verify that required authorizations and referrals are in place before billing.

- Submit claims through the practice management system and clearinghouse.

- Monitor claim status through clearinghouses and payer portals.

- Correct and resubmit rejected or denied claims.

- Identify missing or incorrect information that may delay payment.

- Ensure claims are submitted within payer-specific timely filing requirements.

- Maintain accurate billing records and documentation.

- Eligibility & Prior Authorizations

Verify patient eligibility and benefits prior to services when required.

- Review insurance coverage, deductibles, copays, coinsurance, and authorization requirements.

- Submit and track prior authorization requests.

- Follow up with insurance companies regarding pending authorizations.

- Document authorization information accurately in the practice management system.

- Communicate coverage limitations or authorization issues to the appropriate team.

- Denial Management & AR Follow-Up

- Review denied and rejected claims to determine the reason for non-payment.

- Contact insurance companies to resolve claim issues and obtain payment.

- Submit corrected claims, reconsiderations, and appeals when appropriate.

- Perform regular A/R follow-up on outstanding insurance balances.

- Track unpaid, underpaid, and incorrectly processed claims.

- Maintain detailed notes for all payer interactions and follow-up activities.

Identify recurring denial patterns and communicate them to the management team.

- Escalate complex payer issues when necessary.

- Payment Posting & Reconciliation

- Post insurance payments, patient payments, adjustments, and contractual adjustments accurately.

- Review EOBs/ERAs and reconcile payments against submitted claims.

- Identify underpayments and discrepancies for further investigation.

- Assist with maintaining accurate patient account balances.

Compliance & Quality

-Follow HIPAA, CMS, OIG, and commercial payer requirements.

- Maintain confidentiality and security of patient information.

- Ensure billing activities follow payer-specific requirements and practice policies.

- Support internal billing audits and documentation requests.

- Maintain accurate and timely billing records.

REQUIRED QUALIFICATIONS

- Minimum 3–5 years of hands-on U.S. medical billing experience.

- Experience with professional claims and CMS-1500 billing.

- Strong understanding of insurance eligibility, benefits, authorizations, and claim submission.

- Experience working with commercial insurance, Medicare, Medicare Advantage, and/or Medicaid.

- Experience with claim denials, rejections, corrections, and appeals.

- Strong experience with A/R follow-up and insurance calls.

- Experience using payer portals and clearinghouses.

- Familiarity with EOBs, ERAs, CPT/HCPCS and ICD-10 terminology.

- Strong attention to detail and ability to identify billing discrepancies.

- Excellent written and verbal English communication skills.

- Ability to work remotely while maintaining HIPAA compliance.

- Ability to work during U.S. Eastern Time clinic hours as required.

PREFERRED QUALIFICATIONS

- Experience in behavioral health, pain management, anesthesiology, or specialty practice billing.

- Experience billing for Spravato, ketamine services, infusion services, and/or stellate ganglion blocks.

- Familiarity with New York payers such as CDPHP, MVP, Excellus/BCBS, Fidelis, UnitedHealthcare, Aetna, Cigna, Medicare, and Medicaid managed care.

- Experience working with a small private practice or virtual RCM team.

- Experience handling high-volume claims and A/R follow-up.

- Knowledge of payer-specific billing and authorization requirements.

Interested Candidates can share your CV to [email removed]