Medical Billing Representative

The Medical Billing Representative plays a key role in ensuring prompt and accurate reimbursement for patient services. This full-time position handles monitoring claim status, researching rejections and denials, resolving patient account issues, and securing payment for outstanding balances. 

Success in this role requires strong critical thinking skills, a solid understanding of Medicare, Medicaid, and commercial payer guidelines, and the ability to navigate billing systems efficiently. This individual will communicate frequently with patients, providers, and internal teams to support positive financial outcomes and an excellent patient experience. 

Essential Duties & Responsibilities 

• Maintain consistent availability by phone and proactively make outbound calls. 
• Collect outstanding patient balances and post payments accurately in the Electronic Health Record (EHR). 
• Communicate with providers when documentation is incomplete or insufficient for proper claim adjudication. 
• Correct, complete, and process claims across all payer types as needed. 
• Verify that claims are submitted correctly and educate patients about their balances. 
• Assist with deposit reconciliation and patient payment balancing. 
• Support billing audits by gathering and preparing required information. 
• Process refund requests according to established procedures. 
• Collaborate with billing leads to resolve complex patient account issues. 
• Handle incoming patient billing calls and respond to questions in a professional and timely manner. 
• Review and respond to written correspondence related to patient accounts. 
• Communicate effectively with internal and external stakeholders via phone, email, and written correspondence. 
• Identify trends related to denials, patient balances, or reimbursement issues and escalate findings to the Team Lead/Supervisor. 
• Research account issues, document findings clearly, and communicate next steps to the Team Lead. 
• Stay current on industry updates, payer guidelines, and healthcare billing regulations. 
• Maintain strict confidentiality of all patient information and follow HIPAA standards. 
• Foster a positive, collaborative team environment and contribute to achieving department goals. 
• Demonstrate professionalism, respect, and customer-centered service in all interactions. 
• Perform other related duties as assigned. 

Qualifications To perform this role successfully, an individual must be able to carry out each essential duty with high quality and professionalism. Reasonable accommodations may be made for individuals with disabilities. 

Education & Experience 

• High school diploma or GED required. 
• 2–4 years of medical billing or collections experience preferred. 

Knowledge, Skills & Abilities 

• Effective communication and customer service skills. 
• Proficiency in medical billing workflows, payer requirements, and reimbursement processes. 
• Bilingual skills are preferred. 

Physical Demands The physical requirements listed below represent those that must be met to perform essential job functions. Reasonable accommodations may be made for individuals with disabilities. 

• Light lifting (20–25 lbs.). 
• Ability to work effectively in an office environment. 

Work Environment 

• Office: Office setting using standard office equipment. 
• Travel: Less than 25%.