Medical Biller en RPCI Oncology PC

Description

POSITION TITLE: Medical Biller

LOCATION: Northtowns/Hybrid

REPORTS TO: Manager, Billing

Revised: May 28, 2025

JOB SUMMARY

The Medical Biller is responsible for entering charges and submitting medical claims to insurance companies. This role will work all open accounts for insurances and patient related A/R and attends to all patient and insurance-related inquiries. The Medical Biller is a critical position for the financial cycle of all health care providers.

ESSENTIAL FUNCTIONS

• Prepares, reviews, and transmits claims, both electronic and paper.
• Follows up on unpaid claims within the Billing Department policy timeframe.
• Checks and posts each insurance payment manually or electronically within the Billing Department policy timeframe.
• Calls insurance companies regarding discrepancies in payments if necessary.
• Identifies and bills secondary or tertiary insurances.
• Reviews accounts in patient follow-up.
• Reviews EOBs, appeals and tracks denied claims when necessary.
• Answers all patient, insurance, or staff telephone inquiries pertaining to assigned accounts
• Coordinates with front desk or verification team to ensure active insurance coverage prior to billing.
• Collaborates with other medical coders to clarify diagnosis and procedure codes when discrepancies arise.
• Reconciles submitted claims against remittance advice to identify underpayments or incorrect adjustments.
• Submits and monitors claim status via clearinghouse platforms; addresses rejections in a timely manner.
• Ensures compliance with HIPAA, payer guidelines, and internal billing policies.
• Other additional duties that may be pertinent to the billing department processes.

OTHER DUTIES & RESPONSIBILTIIES

• Sets up payment plans and works collections if assigned.
• Balances all daily receipts and runs final end of day report.
• Runs and manages open item aging reports bi-weekly for patients and insurances.
• Assists with internal audits and supports quality improvement initiatives in the billing process.

KNOWLEDGE/

SKILLS/ABILITIES

• High Energy
• Attention to Detail – thorough in completing work tasks
• Integrity – Being honest and ethical
• Adaptability/Flexibility – Being open to change (positive or negative) and to considerable variety in the workplace
• Dependability – Being reliable, responsible, and dependable, and fulfilling obligations
• Stress Tolerance – Effectively managing a heavy workload; accepting criticism and dealing calmly and effectively with high-stress situations
• Initiative – Ability to identify tangible contribution you alone have made to the organization
• Time management – Managing one’s own time and guiding the time of others
• Working knowledge of medical terminology, CPT/HCPCS coding systems, and ICD-10
• Ability to identify trends in denials and prepare structured appeal letters
• Experience with electronic health records (EHR) and practice management (PM) systems (e.g., Medent, OncoEMR)

EDUCATION & EXPERIENCE

• High school diploma or G.E.D. and the equivalent of one year of full-time clinical or administrative health care experience
• Minimum of one year of experience in a medical billing role, preferably in a multi-specialty or oncology environment
• Experience with the electronic and paper systems used in billing services
• Experience working in Windows and with MS Office software

CERTIFICATIONS/ LICENSES

• Certified Professional Biller (CPB), Certified Billing and Coding Specialist (CBCS), or equivalent preferred.

EQUIPMENT

• Computer, scanner, phone systems, fax machine

PHYSICAL DEMANDS

While performing the duties of the job, an employee is frequently required to sit, and use hands or fingers to manipulate, touch or handle, talk or hear. Regularly required to reach with hands and arms, walk or stand. Occasionally required to climb, balance, stoop, kneel, crouch or crawl. Occasionally required to lift and/or move up to twenty-five (25) pounds. Specific vision abilities required by this job include close vision, color vision and the ability to adjust focus. The physical demands described here are not job requirements but are representative of those demands that are typically expected of employees to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to successfully perform the essential functions

WORK ENVIRONMENT

Work is performed in a typical, busy outpatient clinic environment. Daily exposure to chemotherapy drugs and agents. Material safety data sheets (MSDS) that include information on health hazards, acute exposure treatment, PPE, and spill procedures are accessible. While performing the duties of this job, the employee is occasionally exposed to moving mechanical parts, exposure to infectious diseases, and transmission of airborne disease. The noise level in the work environment is usually moderate.  

NOTE: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification and are not all-inclusive. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. Additional duties and responsibilities may be assigned as business needs require.  

I understand the requirements, essential functions and duties as outlined in the above Job Description.  

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Employee Signature Date