Medical Representative

As a Revenue Cycle Specialist (Medical Biller), you will serve as a bridge between the billing department and third-party payers to resolve overdue claims and collect payments. In this role, you will be responsible for ensuring accurate billing and efficient collections processes within our healthcare organization. This position will report to the Director of Collections.

Essential Duties and Responsibilities:

• Monitor accounts to identify overdue payments and correct errors in previously submitted claims to ensure full payment
• Clearly communicate with team members, third-party payers, and customers regarding identified claims errors via phone and email
• Identify, analyze, and research trends in claims rejections and partial payments to create resolutions
• Prioritize activities to work denials and partial payments in a timely manner to avoid timely filing limitations
• Leverage reporting tools for comprehensive data analysis, creating targeted action plans to resolve billing issues
• Utilize coding systems (CPT, ICD-10) to guarantee meticulous billing and collections
• Process and reprocess medical claims in accordance with payer regulations, protocols, medical authorizations, and departmental guidelines

Experience and Skills

• Minimum of 2 years of experience in medical billing and collections
• Experience working with third-party payers, such as VA, Medicaid, Medicare Advantage, and Worker’s Compensation
• Experience with revenue cycle management
• Experience working with UB04 and HCFA 1500 forms
• Familiarity with Electronic Medical Record (EMR) systems
• Knowledge of health care collections procedure codes and techniques
• Proficiency in using billing software (Clearinghouse) and electronic health records (EHR)
• In-depth knowledge of healthcare billing codes (CPT, ICD-10)
• Proven success in reducing accounts receivable and improving collections
• In-depth knowledge of HIPAA compliance
• Excellent follow-up, time management, and communication skills required
• Familiarity with PowerBI preferred but not required
• Proficiency in MS Office Suite (Outlook, Word, Excel) required