We are seeking an experienced and detail-oriented Medical Biller to join our pediatric practice. The ideal candidate will have strong experience with the full medical billing cycle and be proficient in Office Practicum (OP).
This position will be responsible for managing accurate and timely billing processes, with a particular emphasis on reviewing, reworking, and resolving denied and rejected claims. The ideal candidate will be capable of taking ownership of the billing process from claim submission through payment and resolution while identifying opportunities to improve collections and reduce outstanding accounts.
Key Responsibilities
- Manage the medical billing process from charge entry and claim submission through payment and account resolution.
- Review, research, and rework denied, rejected, and unpaid insurance claims.
- Identify the cause of claim denials and take appropriate corrective action.
- Correct and resubmit claims as necessary, including addressing coding, eligibility, demographic, authorization, and documentation issues.
- Follow up with insurance companies regarding outstanding claims, denials, underpayments, and payment discrepancies.
- Submit appeals and supporting documentation when appropriate.
- Monitor accounts receivable and proactively follow up on outstanding balances.
- Utilize Office Practicum (OP) to manage patient accounts, claims, insurance information, billing history, payments, and reports.
- Review EOBs and ERAs and ensure payments are accurately posted and applied.
- Identify and resolve billing discrepancies and patient account issues.
- Verify insurance eligibility and benefits when necessary.
- Maintain accurate patient demographics and insurance information.
- Work with providers and clinical/administrative staff to resolve issues that may prevent timely claim payment.
- Monitor claims for timely filing requirements and ensure outstanding claims are addressed promptly.
- Identify recurring billing and denial trends and communicate opportunities for improvement to management.
- Assist with patient billing questions and account inquiries as needed.
- Maintain accurate billing documentation and records.
- Ensure all billing practices comply with HIPAA and applicable payer requirements.
- Take on additional billing responsibilities as appropriate, with the opportunity to assume primary responsibility for the practice's overall billing operations.
Required Qualifications
- Previous experience in medical billing, preferably in a physician or pediatric practice.
- Strong understanding of the full medical billing cycle.
- Demonstrated experience with insurance claims, denials, appeals, payment posting, EOBs/ERAs, and accounts receivable.
- Proficiency with Office Practicum (OP) strongly preferred.
- Experience communicating with insurance companies to resolve claim and payment issues.
- Strong attention to detail and accuracy.
- Excellent organizational and follow-through skills.
- Ability to work independently and manage multiple priorities.
- Strong written and verbal communication skills.
- Knowledge of HIPAA and patient confidentiality requirements.
Preferred Qualifications
- Experience working in a pediatric medical practice.
- Experience identifying and correcting recurring billing issues.
- Medical billing certification (CPC, CPB, CBCS, or similar) is a plus.
Ideal Candidate
We are looking for someone who is experienced, proactive, and capable of taking ownership of the billing process. While a significant initial focus will be on resolving outstanding and denied claims, the ideal candidate will have the knowledge and ability to handle all aspects of medical billing and ultimately serve as a primary resource for the practice's billing operations.
The successful candidate should be comfortable working independently, navigating Office Practicum, communicating with insurance companies, researching complex claim issues, and following accounts through to resolution. Strong problem-solving skills, attention to detail, and persistence are essential.
Work Environment
This is an on-site position within a busy pediatric medical practice. The position requires regular interaction with practice management and clinical/administrative staff and will involve working directly with patient accounts, insurance claims, and billing records.