Medical Biller

Key Responsibilities

Authorization Management

Obtain and verify prior authorizations for services, treatments, and procedures.
Review patient insurance eligibility and benefits to ensure coverage requirements are met.
Submit authorization requests accurately and timely through payer portals, fax, or phone.
Track authorization status and follow up with insurance companies as needed.
Maintain accurate documentation of authorization approvals, denials, and expiration dates.
Communicate authorization updates to clinical and scheduling teams.

Denial Management

Review denied or rejected claims to identify root causes and trends.
Research payer policies and determine appropriate corrective actions.
Prepare and submit appeals with supporting documentation within payer deadlines.
Work collaboratively with billing, coding, and clinical departments to resolve claim issues.
Monitor denial reports and maintain denial logs for tracking and reporting purposes.
Escalate unresolved or recurring denial issues to leadership.

Revenue Cycle Support

Assist with claim edits, payment posting discrepancies, and reimbursement follow-up.
Ensure compliance with payer guidelines, CMS regulations, and company policies.
Support process improvement initiatives aimed at reducing denials and increasing collections.
Maintain confidentiality of patient and financial information in accordance with HIPAA regulations.
Participate in audits, training, and departmental meetings as required.
Fosters a culture of customer service and commitment to quality care
Shows a genuine interest and compassion for the communities we serve and commitment to the diversity of our clients and team members
Mentor and supports team members
Complete other tasks as assigned

Requirements

What we are looking for:

High school diploma or equivalent required; Associate’s degree preferred.
Minimum of 2 years of experience in healthcare revenue cycle, medical billing, authorizations, or denial management.