Medical Biller

Eyesight Ophthalmic Services•Somersworth, NH

2d•$21 - $23•Onsite

About The Position

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.

Requirements

High school diploma or GED required
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

Nice To Haves

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

Responsibilities

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