Medical Biller - Revenue Cycle Specialist

KEY RESPONSIBILITIES

1. Full Revenue Cycle Ownership

• Process claims from charge entry through payment posting, including corrections and appeals.
• Ensure timely submission of clean claims across all payers and specialties.
• Monitor claims status daily; resolve holds, rejections, and payer edits promptly.
• Maintain a high first-pass acceptance rate for all claims.

2. Denial Management & Appeals

• Investigate and resolve denials with strong understanding of payer policies.
• Draft clear, compelling appeals supported by documentation and correct coding rules.
• Identify root causes of recurring denials and propose preventative solutions.
• Track denial trends and communicate action steps to coding, providers, and leadership.

3. Accounts Receivable Management

• Maintain AR days within benchmarks set by leadership.
• Work aged AR efficiently with prioritization of high-value and time-sensitive claims.
• Conduct routine AR audits to ensure accurate balances and payer compliance.
• Communicate effectively with payers to resolve pending issues and secure payment.

4. Coding Validation & Documentation Support

• Collaborate with coding team to ensure claims reflect accurate ICD-10, CPT, and HCPCS assignments.
• Escalate documentation concerns to providers or coders with clear recommendations.
• Stay current on payer-specific policies, CCI edits, bundling rules, and CMS updates.
• Provide feedback to clinical teams on documentation patterns that affect reimbursement.

5. Patient Account Resolution

• Assist with patient billing questions, balances, and payment plans.
• Work alongside front desk and call center to ensure insurance verification accuracy and prevent downstream billing issues.
• Maintain professionalism and empathy when interacting with patients.

6. Reporting & Performance Tracking

• Prepare weekly and monthly RCM performance reports as needed.
• Track claim status, denial patterns, AR aging, and reimbursement fluctuations.
• Provide insights and recommendations to leadership for improvement opportunities.