Medical Biller

The Medical Biller supports the full revenue cycle by preparing and submitting accurate claims, reviewing coding and payer requirements, posting and reconciling payments, resolving denials and outstanding accounts, and assisting patients with billing questions.  Team members may be assigned primary areas of responsibility based on departmental needs, experience, and training while providing cross-coverage for other billing functions.

Core Behavioral Values:

• CLEAR ID: Collaborate, Learn, Empathy, Accountable, Respect, Integrity, Dedication
• These behaviors are based on Eyesight’s culture and values critical to support the organizations mission of providing uncompromising care to patients. 

Essential Functions

• Review and validate claims for accurate patient, insurance, diagnosis, procedure, modifier, and other required information
• Prepare, correct, and submit clean claims to insurance companies in accordance with payer and organizational requirements
• Apply knowledge of CPT, ICD-10, HCPCS, ophthalmology-specific coding, and applicable state and federal guidelines
• Research and resolve claim rejections, denials, underpayments, unpaid claims, and other accounts receivable issues
• Prepare and submit appeals with the documentation needed to support timely and accurate reimbursement
• Post and reconcile patient and insurance payments, including checks, electronic fund transfers, credit card transactions, and explanation of benefits
• Process appropriate adjustments, credits, refunds, and corrections while maintaining accurate financial records
• Respond professionally to patient calls, messages, and questions regarding balances, insurance processing, financial obligations, and payment options
• Collect patient payments and assist with payment plans in accordance with organizational policies
• Update patient, guarantor, and insurance information when discrepancies or changes are identified
• Manage assigned billing communications, tasks, faxes, referrals, payer requests, and supporting documentation
• Assist with specialized billing functions such as Veterans Affairs, workers’ compensation, surgical billing, end-of-day reconciliation, fee schedules, and financial reporting as assigned
• Support prior authorization and insurance-verification functions within the scope of the employee’s training and assigned responsibilities
• Identify opportunities to improve billing accuracy, efficiency, compliance, and overall revenue cycle performance
• Maintain organized documentation and comply with internal SOPs, HIPAA requirements, payer guidelines, and organizational policies
• Provide cross-coverage and assist with other revenue cycle responsibilities as needed

Qualifications

• High school diploma or GED required
• Experience in medical billing, coding, accounts receivable, payment posting, or a related healthcare setting preferred
• Working knowledge of medical terminology, insurance guidelines, and claim-processing requirements
• Strong analytical, problem-solving, organizational, and time-management skills
• Excellent written and verbal communication skills
• Ability to work independently while collaborating effectively with patients, providers, payers, and internal teams

Preferred

• Medical billing or coding certification
• Ophthalmology billing and coding experience
• Proficiency in EMR/PM systems (experience with ModMed a plus)
• Knowledge of Medicare, Medicaid, commercial insurance, HIPAA, and patient privacy standards

Work Conditions

• Professional healthcare setting, including clinics, administrative areas, and patient-facing environments
• Noise level ranges from quiet to moderate, depending on location and activity
• Potential exposure to infectious diseases, bodily fluids, or cleaning agents in accordance with standard protocols

Physical Requirements

• Ability to sit, stand, and walk for extended periods
• Frequent use of hands and fingers to operate medical or office equipment
• Effective verbal and written communication; ability to hear and understand speech in person and by phone
• Close vision required for reading small print and viewing computer screens
• Occasional lifting or moving of objects up to 25 pounds
• May involve reaching, bending, stooping, kneeling, or other physical movement
• Ability to manage multiple priorities and maintain professional interactions in a dynamic setting