Certified Medical Biller

Job Summary

The Certified Professional Biller (CPB) is responsible for managing the full medical billing process to ensure accurate claim submission, timely reimbursement, and compliance with payer and regulatory requirements. This role requires strong knowledge of medical billing practices, insurance guidelines, and revenue cycle management. The CPB works closely with providers, coders, and administrative staff to resolve billing issues, reduce denials, and maximize reimbursement while maintaining accurate documentation and compliance standards.

Key Responsibilities

• Prepare, review, and submit accurate medical claims to insurance payers in a timely manner.
• Verify billing data for completeness and accuracy, including diagnosis codes, procedure codes, modifiers, and patient demographics.
• Monitor claim status and follow up with insurance companies regarding unpaid, rejected, or denied claims.
• Investigate and resolve claim denials, rejections, and underpayments.
• Post insurance payments, adjustments, and patient payments accurately in the billing system.
• Review explanation of benefits (EOBs) and electronic remittance advice (ERAs) for accuracy.
• Communicate with patients regarding billing questions, insurance coverage, and outstanding balances when necessary.
• Work closely with coding and clinical staff to resolve documentation or coding discrepancies.
• Maintain compliance with payer guidelines, billing regulations, and HIPAA requirements.
• Assist in identifying billing trends, errors, and opportunities to improve revenue cycle performance.
• Maintain accurate records of billing activities and claim follow-ups in the practice management system.

Performance Metrics (KPIs)

The Certified Professional Biller will be evaluated based on the following key performance indicators:

• Clean Claim Rate: Maintain a clean claim submission rate of 95% or higher (claims accepted on first submission).
• Claim Submission Timeliness: Ensure 95% of claims are submitted within 48–72 hours of charge entry.
• Denial Rate: Maintain a claim denial rate below 5–7% through accurate billing and follow-up.
• Accounts Receivable (AR) Days: Support maintaining AR days under 35–40 days for the organization.
• Denial Resolution Turnaround: Denied claims reviewed and resubmitted within 7–10 business days.
• Collection Accuracy: Maintain 98–100% accuracy in payment posting and billing adjustments.
• Revenue Recovery: Successfully resolve and recover payments from denied or underpaid claims.
• Compliance & Documentation: Ensure 100% compliance with billing documentation standards and regulatory requirements.

Qualifications

• Certified Professional Biller (CPB) certification required (such as through AAPC).
• High school diploma required; associate degree in healthcare administration, billing, or related field preferred.
• 2–4 years of medical billing experience in a healthcare practice, hospital, or billing company preferred.
• Strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
• Experience with insurance claims, EOBs, ERAs, and denial management.
• Proficiency with electronic health records (EHR) and practice management systems.
• Strong analytical, problem-solving, and organizational skills.
• Excellent communication and attention to detail.

Pay: $21.00 - $24.00 per hour

Benefits:

• Health insurance
• Paid time off

Application Question(s):

• May we contact your current Supervisor/Manager?

Experience:

• Medical billing: 2 years (Required)

Location:

• Henrico, VA 23233 (Required)

Ability to Commute:

• Henrico, VA 23233 (Required)

Work Location: In person

Salary : $21 - $24