Medical Biller

• Prepare and submit insurance claims for ophthalmology, optometry, retina, and ASC services
• Utilize CPT, ICD-10, and HCPCS codes for accurate and compliant claims submission
• Review and resolve coding discrepancies and claim denials
• Track, review, and follow up on unpaid or denied claims
• Work with insurance carriers to resolve payment delays, appeals, and denials
• Post payments and adjustments accurately and timely
• Communicate with patients about billing issues, account discrepancies, and outstanding balances
• Collaborate with clinical and administrative teams to streamline billing workflows
• Stay updated on coding guidelines, payer policies, and industry best practices

• Manage the full revenue cycle process for assigned medical practices
• Submit, track, and monitor insurance claims through Athenahealth
• Resolve claim issues affecting reimbursement
• Perform accounts receivable follow-up and collections activities
• Investigate claim denials, research root causes, submit appeals, and resolve reimbursement discrepancies
• Review aging reports and prioritize outstanding receivables
• Communicate with insurance carriers regarding claim status and payment discrepancies
• Document billing activities and maintain accurate billing records and reports
• Share billing performance insights, operational issues, and process improvement opportunities with leadership
• Support workflow distribution and collaborate with offshore billing resources
• Provide customer service support to physicians and practice stakeholders
• Support multiple physician practices and manage priorities across client accounts
• Build and refine internal RCM processes, tools, and workflows as the department scales
• Work primarily in Athenahealth and potentially use Tebra, Charm Health, AdvancedMD, HubSpot, and Zendesk

• Perform end-to-end revenue cycle tasks, including transactions, AR, coding, reconciliations, denials, and appeals
• Navigate federal, state, and payer websites to support billing and compliance
• Research coding and billing requirements to ensure accurate submissions
• Collaborate across departments to meet customer needs and support organizational goals
• Participate in committees, mentor junior team members, and support training initiatives
• Analyze workflows and recommend best practices using NextGen PM

• Handle prior authorizations for surgical cases
• Verify patient eligibility and benefits
• Submit claims and ensure clean claims are sent
• Work denials and accounts receivable
• Post payments
• Obtain authorization approval before surgical cases
• Resolve denied or unpaid claims
• Support a single-provider orthopedic spine surgery practice
• Manage multiple patient accounts independently
• Communicate with payers and patients by phone

Medical Biller – Orthopedic

• Manage the full revenue cycle process for assigned medical practices
• Submit, track, and monitor insurance claims through Athenahealth
• Perform accounts receivable follow-up and collections activities
• Investigate claim denials, research root causes, submit appeals, and resolve reimbursement discrepancies
• Review aging reports and prioritize outstanding receivables
• Communicate with insurance carriers regarding claim status and payment discrepancies
• Document billing activities and maintain accurate billing records and reports
• Share billing performance insights and process improvement opportunities with leadership
• Support workflow distribution and collaborate with offshore billing resources
• Provide customer service support to physicians and practice stakeholders
• Support multiple physician practices and manage priorities across client accounts
• Build and refine internal RCM processes, tools, and workflows as the department scales