Medical Biller

The Medical Biller plays a crucial role in optimizing revenue recovery by reviewing, analyzing, and resolving insurance payer denials. This position is focused on managing denial resolution, handling appeals, conducting root-cause analysis, and collaborating with internal teams to reduce future denials and improve billing efficiency. The role requires attention to detail and a proactive approach to ensure claims are accepted and revenue is maximized.

Key Responsibilities

- Review denial codes, Explanation of Benefits (EOBs), and payer correspondence to identify issues.
- Investigate denied claims and determine the appropriate corrective actions, such as resubmitting corrected claims, filing appeals, or requesting additional documentation.
- Prepare and submit comprehensive appeal packets, including clinical documentation, appeal letters, and supporting evidence.
- Follow up with payers to ensure timely resolution of denied claims.
- Analyze and categorize denials by cause, including coding errors, eligibility, authorization, bundling, and documentation issues.
- Identify recurring denial trends and escalate findings to leadership to support process improvements.
- Recommend corrective actions to minimize future denials and improve first-pass claim acceptance rates.
- Maintain accurate denial logs documenting actions taken, outcomes, and revenue recovered.
- Generate weekly and monthly denial management reports that include actionable insights and recommendations.
- Monitor appeal timelines to ensure compliance with payer requirements.
- Collaborate closely with coding, billing, charge entry, and clinical teams to resolve denial-related issues.
- Provide feedback and education to internal teams regarding recurring denial patterns and payer requirements.
- Support workflow improvements aimed at enhancing overall revenue cycle performance.

Required Qualifications

- Minimum of 2 years of experience in Denial Management, Accounts Receivable (AR) Follow-Up, or Revenue Cycle Management.
- Strong understanding of payer policies, appeal processes, denial management workflows, and CARC/RARC codes.
- Excellent analytical and problem-solving skills.
- Strong written communication abilities.
- Ability to prioritize workload effectively and meet deadlines in a fast-paced environment.

Preferred Qualifications and Benefits

Experience with specialty care denials, particularly related to Retina or Ophthalmology claims, is highly desirable. Familiarity with payer portals and electronic appeal submission processes is also preferred. Candidates with experience working with Practice Management/Electronic Health Record (PM/EHR) systems such as Healthpac, NextTech, ModMed, eClinicalWorks (ECW), Athena, MedInformatics, and AdvancedMD will have an advantage.

The position offers a competitive salary package along with opportunities for professional growth and development. Employees will benefit from a collaborative and supportive work environment and gain exposure to advanced healthcare revenue cycle operations.