Senior Medical Biller

Job Overview
We are seeking a highly skilled and detail-oriented Senior Medical Biller to join our busy pediatric practice. The ideal candidate will possess extensive experience in medical billing and coding, with a strong understanding of medical terminology, insurance procedures, and electronic health record systems. This role handles complex billing issues and ensures claims meet payer standards and reimbursement requirements. Responsibilities include all aspects of billing including insurance submissions, claim denials, insurance and private accounts receivable follow-up. This role requires a proactive approach to resolving billing discrepancies and a commitment to maintaining compliance with healthcare regulations.

Responsibilities

• Ensure timely and accurate payment posting and adjustments; monitor accounts receivable and ensure balances are collected efficiently
• Check each insurance payment for accuracy and compliance with contract discount including ensuring account adjustments are made according to established policy and procedures
• Resolve billing discrepancies, submitting corrected claims, appeal denials, and underpayments by following up with insurance companies and patients in a timely manner
• Identifying and billing secondary insurances
• Following up on unpaid claims
• Identify patterns in claim denials or billing errors and set up workflows to reduce errors
• Being point person with CMG/Privia ACO.
• Contact patients to collect appropriate information or to collect patient balances.
• Communicate coverage details, patient responsibilities, and financial agreements clearly with patients.
• Answering patients' billing and insurance inquiries, as well as handling billing related complaints
• Reviewing uncollected accounts and preparing information for the collection agency
• Audit Provider charts and notes to ensure coding accuracy, compliance and optimal reimbursement
• Provide feedback to providers regarding documentation needed to support compliant coding
• Preparing and submitting billing data and medical claims to insurance companies, when other billers are out of office
• Seeks clarification from physicians or other staff in cases where documentation is absent, ambiguous, or contradictory. Makes corrections based on collaboration with provider
• Ensure documentation supports billed services
• Maintaining billing software, updating rate changes, and generating financial reports
• Ability to assess financial summaries and spot discrepancies for accurate billing
• Collaborate with the billing, clinical, and front desk teams on patient and insurance issues
• Prioritizing tasks to stay organized and meet deadlines
• Protect patient confidentiality and comply with HIPAA regulations.

Experience

• 4 years of billing/collections experience in a healthcare environment
• Advanced working knowledge of CPT, ICD-10, and HCPCS codes and insurance reimbursement processes.
• Proficiency in billing software, EMR systems, and Microsoft Office (Excel required)
• Knowledge of navigating payer portal (Cigna, UHC, CTCare, etc) and strong familiarity with clearing house platforms such as Availity.
• Experience and knowledge of requirements for both commercial carriers and Medicaid.
• Demonstrated experience resolving complex claim denials and payer appeals.
• Experience conducting coding reviews and documentation audits to ensure claims meet payer documentation standards.
• Demonstrate leadership and coach junior billing staff.
• Strong communication, organizational, and analytical skills.
• High attention to detail and accuracy in data entry and documentation.
• High school diploma or equivalent (Associate degree preferred).

Pay: $55,000.00 - $70,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Flexible spending account
• Health insurance
• Paid time off
• Retirement plan

Work Location: In person

Salary : $55,000 - $70,000