Medical Biller I
About The Position
Exagen is a patient-focused, discovery-driven life sciences company working to transform care for patients with chronic autoimmune diseases. Its technology supports rheumatologists in diagnosing, prognosing, and monitoring complex autoimmune conditions, including lupus and rheumatoid arthritis. Under the direction of the Billing Team Lead, the Medical Biller manages claims from submission through adjudication and processes appeals and grievances. The role involves researching, evaluating, responding to, and closing appeals; building case files for grievances; and ensuring compliance with organizational and regulatory guidelines. Qualified candidates have extensive knowledge of medical and third-party billing procedures, policies, and concepts, as well as an understanding of federal and state health programs and PPO, HMO, and indemnity plans.
Requirements
- At least 2 years of experience; laboratory billing experience is preferred.
- Strong understanding of insurance billing, including Medicare, Medicaid, and commercial insurance plans.
- Ability to identify payer and denial trends and provide solutions for process improvements and enhancements.
- Excellent analytical skills.
- Working knowledge of CPT, ICD-10, and HCPCS coding systems, coverage (LCD/NCD), and reimbursement associated with those codes.
- Effective problem-solving skills in a fast-paced, rapidly changing environment.
- Excellent verbal and written communication skills.
- Proficiency in Microsoft Excel.
Nice To Haves
- Laboratory billing experience.
- Quadax experience is strongly desired.
Responsibilities
- Review and reconcile accounts, identifying and resolving discrepancies.
- Collaborate with internal teams to obtain documentation and information needed for billing.
- Manage the submission, intervention, and resolution of appeals, grievances, and complaints.
- Research, evaluate, respond to, and complete appeals and other inquiries accurately and promptly in accordance with regulatory guidelines.
- Prepare appeals summaries and correspondence, and document information for tracking and trend analysis.
- Assist with processing incoming and outgoing correspondence.
- Assist with requesting and processing patient medical records.
- Ensure provider appeals are timely and appropriate under federal and state guidelines.
- Maintain accurate and organized billing records and documentation.
- Perform other duties as assigned.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Health Care and Dependent Care Flexible Spending Accounts
- 401(k) retirement savings program
- Four weeks of paid time off
- Paid company holidays
- Employer-paid life insurance
- Optional life insurance
- Employer-paid short-term disability insurance
- Employer-paid long-term disability insurance
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
