Medical Biller

Experience Level : 3+ years.Primary Roles & ResponsibilitiesABA billing experience. TMS (Transcranial Magnetic Stimulation)1. Claim Preparation and Submission Collect and verify patient and insurance details. Translate physician services into billable codes (often in collaboration with a medical coder). Accurately generate insurance claims usingCPT, ICD-10, and HCPCScodes. Submit claims electronically or via paper to insurance payers (Medicare, Medicaid, private insurers). 2. Insurance Verification and Preauthorization (Calling & Online Checking) Confirm patient insurance eligibility and coverage before services are rendered. Obtain prior authorizations when required by insurance providers. 3. Claim Follow-Up Monitor submitted claims for acceptance, rejection, or denial. Identify and correct any denied or rejected claims. Resubmit corrected claims promptly. 4. Payment Posting and Reconciliation Post insurance and patient payments in the billing system. ReviewEOBs (Explanation of Benefits)andERAs (Electronic Remittance Advice) . Reconcile posted payments with deposits and patient accounts. 5. Patient Billing and Communication Generate and send patient statements electronically for outstanding balances. Communicate with patients (if approved by doctors) regarding billing issues, insurance questions, and payment options. Assist in setting up payment plans if necessary. 6. Compliance and Confidentiality Ensure full compliance withHIPAAand all relevant billing laws. Maintain strict confidentiality of patient and financial data. Stay updated with changing payer guidelines, coding rules, and healthcare regulations. 7. Reporting and Documentation Generate billing and financial reports for physicians or practice managers. Maintain accurate records for internal reviews and external audits.Skills & Knowledge Required Strong understanding ofmedical terminology, anatomy , and medical coding systems ( ICD-10, CPT, HCPCS ). Proficiency with billing software (e.g.,Kareo, AdvancedMD, Athenahealth ) –varies by client requirements . Familiarity with specific specialties (e.g.,Mental Health, Pediatrics, Internal Medicine, Cardiology, Orthopedics , etc.) –client-dependent . Excellent attention to detail and organizational skills. Effective communication and customer service abilities. Solid knowledge of payer-specific rules and federal programs likeMedicare / Medicaid/ Commercial insurance.

Created: 2025-08-04