Medical Biller - Plastic Surgery (AR & Denial Management Focus)

Position Overview

We are seeking a detail-oriented and experienced Medical Biller with a strong background in plastic surgery billing and insurance follow-ups. The ideal candidate has hands-on experience handling Anthem BCBS claims, denial management, and preventing recoupments. This role requires strong analytical skills, persistence in AR follow-ups, and accuracy in claims processing.

This is a critical role that directly impacts revenue cycle performance and reimbursement timelines.

Key Responsibilities

Claims Processing & Submission

• Submit accurate and timely claims for plastic surgery procedures
• Review documentation for coding and billing accuracy
• Ensure proper modifier usage when applicable

Insurance Verification & Payer Communication

• Work extensively with Anthem BCBS
• Verify benefits and confirm coverage for procedures
• Communicate with insurance representatives regarding claim status

Denial Management

• Analyze denied claims and identify root causes
• Prepare and submit appeals with supporting documentation
• Track and resolve denied and rejected claims promptly

Accounts Receivable (AR) Management

• Follow up on outstanding claims
• Monitor aging reports
• Reduce AR days through consistent follow-ups

Required Experience

• Proven experience in plastic surgery billing
• Strong experience handling Anthem BCBS claims
• Hands-on experience with claims denial management
• Experience preventing and managing recoupments
• Proficient in:
• Availity
• Practice Fusion

Technical Skills

• Strong knowledge of CPT, ICD-10, and HCPCS coding
• Understanding of payer guidelines and insurance workflows
• Ability to interpret EOBs and ERA reports
• Experience working AR aging reports

Soft Skills

• Detail-oriented and highly organized
• Strong problem-solving skills
• Excellent communication skills (written and verbal)
• Ability to work independently and meet productivity targets

Performance Expectations

• Maintain clean claims submission rate
• Reduce denial percentage
• Improve AR turnaround time
• Minimize recoupments through proactive review