Medical Biller

The Cardiovascular Care Group•Springfield, NJ

1d•Onsite

About The Position

The Medical Biller reports to the Revenue Cycle Manager and is responsible for accurate, timely posting of insurance and patient payments, reconciling remittances, and following up on outstanding insurance balances. The role requires extensive experience with EOB and ERA posting, insurance denial management, and payer-specific reimbursement methodologies. This position is performed on-site in the office five days a week. The Medical Biller manages insurance accounts receivable, investigates unpaid, partially paid, and denied claims, and conducts follow-up with payers to resolve outstanding balances. The role also prepares reconsiderations, corrected claims, and appeals; tracks appeals through resolution; and collaborates with providers, coding staff, and management to support successful outcomes. Surgical billing support includes reviewing surgical claims, understanding surgical billing concepts, and supporting vascular laboratory, vascular surgery, and related specialty billing functions. The position requires at least three years of medical billing experience focused on insurance accounts receivable and payment posting, as well as at least three years of surgical practice billing experience. Vascular surgery experience is strongly preferred. A high school diploma or equivalent is required; an associate’s or bachelor’s degree in a related field and medical billing or coding certification are preferred or a plus.

Requirements

At least 3 years of medical billing experience, primarily focused on insurance accounts receivable and payment posting.
At least 3 years of surgical practice billing experience.
Extensive experience posting EOBs, ERAs, EFTs, and manual payments.
Proven success resolving insurance denials, underpayments, and aging accounts receivable.
Strong working knowledge of UnitedHealthcare, Aetna, Horizon Blue Cross Blue Shield, Medicare, and commercial payer reimbursement methodologies.
Experience preparing and submitting reconsiderations, corrected claims, and formal appeals.
Thorough understanding of medical terminology, insurance billing practices, CPT, ICD-10, modifiers, and claim adjudication processes.
Proficiency with electronic health record (EHR) and practice management systems.
Strong analytical, organizational, and problem-solving skills.
Exceptional attention to detail and commitment to accuracy.
Ability to prioritize multiple responsibilities and meet established deadlines.
Excellent written and verbal communication skills.
High school diploma or equivalent required.

Nice To Haves

Vascular surgery experience is strongly preferred.
Experience with vascular surgery, general surgery, or other surgical specialties.
Familiarity with payer portals and electronic claims management systems.
Knowledge of Medicare Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and commercial payer medical policies.
Revenue cycle management and denial prevention experience.
Associate’s or bachelor’s degree in Healthcare Administration, Business, or a related field.
Medical Billing or Coding certification.

Responsibilities

Accurately post insurance and patient payments from EOBs, ERAs, EFTs, lockbox files, credit cards, cash, and paper checks.
Review and reconcile remittance advice, applying payments, adjustments, contractual allowances, deductibles, coinsurance, and patient responsibilities correctly.
Research underpayments, overpayments, payment variances, and reimbursement discrepancies.
Balance daily payment posting batches and reconcile deposits with bank deposits and practice management system records.
Maintain complete and accurate payment transaction documentation and remittance records.
Manage assigned insurance A/R work queues and follow up on outstanding claims.
Analyze unpaid, partially paid, and denied claims to identify causes and corrective actions.
Follow up with payers through portals, telephone, and written correspondence.
Monitor aging reports and prioritize accounts to maximize collections and reduce days in A/R.
Escalate complex reimbursement issues and payer trends to Billing Management.
Review denial codes, payer policies, medical necessity determinations, bundling edits, authorization issues, and coding-related denials.
Prepare and submit reconsiderations, corrected claims, and formal appeals with supporting documentation.
Work with providers, coding staff, and management to obtain documentation supporting appeals.
Track appeal status and follow up through final resolution.
Apply knowledge of surgical billing concepts, including global surgical periods, modifiers, operative reports, authorizations, and payer reimbursement guidelines.
Review surgical claims for completeness and identify reimbursement issues.
Collaborate with coding and billing teams to support accurate claim submission and payment resolution.
Support vascular laboratory, vascular surgery, and related specialty billing functions as needed.
Maintain accurate electronic records and documentation in the practice management system.
Respond professionally to billing and payment inquiries from patients, providers, staff, and insurance representatives.
Assist with special projects, reporting, and revenue cycle initiatives as assigned.
Support the practice’s financial performance and collection efforts.

Benefits

Excellent work/life balance.
Medical coverage, with the Cigna Bronze plan paid 100% by the group for employee-only coverage.
Dental insurance with three plans to choose from through Delta Dental and Cigna.
Vision insurance with two plans to choose from through Delta VSP.
Health Savings Account and Flexible Spending Accounts for healthcare, dependent care, transit, and parking through Upswing.
$25,000 life insurance paid by the group, with optional additional voluntary life insurance coverage.
Short-term and long-term disability through New York Life, with optional additional voluntary coverage.
Optional accident, critical illness, and hospital indemnity benefits through New York Life.
Paid time off.
Holiday pay.
One day of paid jury duty at full pay.
Employee Assistance Programs through RWJBH and Cigna.
401(k) employer contributions of 3% upon eligibility.
Working Advantage and Life Mart employee discounts.
Employee engagement events, including a holiday party, employee appreciation days, ice cream socials, fundraisers, and contests with prizes.