Certified Medical Biller

Job Description

Job Description

Position Summary

The Medical Biller is responsible for the accurate entry of patient charges, coding, claims submission, payment posting, insurance follow-up, and patient account management. This position supports the revenue cycle by ensuring timely and accurate billing processes, maintaining compliance with payer requirements, and providing exceptional customer service to patients and internal staff.

Essential Duties and Responsibilities

Billing, Charge Entry, and Coding

• Accurately enter patient demographics, insurance information, charges, and payments into the billing system.

• Review provider documentation, encounter forms, and superbills to ensure complete and accurate charge entry.

• Assign appropriate ICD-10, CPT, and HCPCS codes for routine services based on provider documentation and established coding guidelines.

• Verify that diagnosis and procedure codes support medical necessity and payer requirements.

• Identify missing, incomplete, or inconsistent documentation and communicate with providers or clinical staff for clarification.

• Review charge entry batches for accuracy prior to claim submission.

• Prepare and submit electronic and paper claims to insurance carriers in a timely manner.

• Correct and resubmit rejected or denied claims as directed.

• Maintain current knowledge of coding updates, payer guidelines, and billing regulations.

• Escalate complex coding or documentation issues to management as appropriate.

Accounts Receivable and Insurance Follow-Up

• Monitor outstanding claims and accounts receivable balances.

• Contact insurance companies regarding claim status, payment delays, denials, and appeals.

• Investigate and resolve billing discrepancies and claim issues.

• Follow up on unpaid or underpaid claims to ensure maximum reimbursement.

• Document all insurance and patient communications within the billing system.

• Assist with denial resolution and claim correction activities.

Payment Posting and Patient Account Management

• Accurately post insurance and patient payments.

• Reconcile payment information and identify account discrepancies.

• Prepare and send patient statements.

• Respond to patient inquiries regarding billing, insurance payments, account balances, and payment options.

• Establish payment arrangements in accordance with practice policies.

• Follow up on delinquent patient accounts and document collection efforts.

Administrative and Reporting Functions

• Answer billing-related telephone inquiries in a professional and courteous manner.

• Maintain organized billing records and supporting documentation.

• Participate in staff meetings, training programs, and continuing education activities.

Compliance and Professional Standards

• Maintain strict confidentiality of patient and organizational information.

• Adhere to HIPAA regulations and all federal, state, and payer requirements.

• Conduct all duties in accordance with organizational policies and procedures.

• Demonstrate professionalism, integrity, and excellent customer service in all interactions.

• Maintain effective working relationships with patients, providers, insurance representatives, and coworkers.

Qualifications

Knowledge, Skills, and Abilities

• Knowledge of medical billing, insurance claims processing, and reimbursement practices.

• Basic to intermediate understanding of ICD-10-CM, CPT, and HCPCS coding.

• Ability to accurately perform charge entry from provider documentation.

• Familiarity with medical terminology and healthcare documentation.

• Proficiency in Microsoft Office applications, including Word and Excel.

• Experience using medical billing software and electronic medical record systems.

• Strong attention to detail and organizational skills.

• Excellent communication and customer service abilities.

• Ability to analyze and resolve billing issues effectively.

• Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment.

Education and Experience

Required

• High School Diploma or GED.

• Minimum of one (1) to three (3) years of medical billing, healthcare office, or related experience.

Preferred

• Experience with physician practice billing.

• Experience using EPIC or other electronic medical record systems.

• Experience with charge entry and basic medical coding.

Language Requirements

• Fluent in English, both written and verbal.

Work Environment

• Office-based healthcare environment.

• Frequent interaction with patients, providers, insurance companies, and staff.

• Ability to manage multiple priorities and interruptions while maintaining professionalism.

• Participation in continuing education and training programs as required.

Physical Requirements

• Prolonged periods of sitting and computer use.

• Ability to stand, walk, bend, and reach throughout the workday.

• Ability to lift and carry files and office materials up to 15 pounds.

Other Requirements

• Maintains confidentiality of organizational and patient records.

• Demonstrates reliability, accountability, and professionalism.

• Possesses reliable transportation if required by organizational needs.

• Supports the mission, values, and goals of the organization.