About This Role
Working independently to review claims, identify billing problems, and resolve denials is at the heart of this role for an experienced medical biller. The specialist will support a growing multi-specialty healthcare organization providing urgent care, primary care, and behavioral/mental health services, helping ensure services are properly billed and collected. This is not an entry-level position.
Responsibilities
- Review encounters and claims prior to submission
- Verify that claims contain appropriate CPT, ICD-10, and HCPCS information
- Review modifiers and place-of-service requirements
- Check billing provider, rendering provider, NPI, and taxonomy information
- Review claims for potential billing or documentation issues before submission
- Electronic and paper claim submission
- Work clearinghouse rejections
- Review EOBs and ERAs
- Payment posting and reconciliation
- Follow up on unpaid and underpaid claims
- Work insurance denials from beginning through resolution
- Submit corrected claims and appeals
- Identify recurring denial patterns and correct the underlying cause
- Monitor timely-filing deadlines
- Check patient eligibility and benefits
- Review authorization and referral requirements
- Work payer portals
- Follow up directly with insurance companies when necessary
- Maintain accurate notes regarding claim follow-up
- Review aging reports and prioritize outstanding A/R
- Identify claims that have been submitted incorrectly or have not been submitted
- Communicate billing/documentation issues to providers and management
- Help improve clean-claim rates and overall collections
Requirements
- Minimum 3–5 years of hands-on medical billing experience
- Experience with several of the following:
- Medicare
- Medi-Cal
- Managed Medi-Cal
- Commercial insurance
- PPO/HMO plans
- Urgent care billing
- Primary care billing
- Behavioral health / mental health billing
- Psychiatrist and psychiatric NP billing
- Therapy/psychotherapy billing
- Physician, NP, and PA billing
- Denials and appeals
- A/R follow-up
- Strong attention to detail, accountability, and follow-through
Nice to have:
- 5+ years of experience
- Behavioral health billing experience