Medical Billing Representative

Carolina Digestive Health Associates PA•Charlotte, NC

5d•Onsite

About The Position

The Medical Billing Representative supports the revenue cycle by monitoring claim status, researching and resolving claim rejections and denials, collecting outstanding balances, and responding to patient billing inquiries. The role works with providers, patients, insurance companies, and internal departments to help ensure accurate claim processing and timely payment. The representative handles claims for Medicare, Medicaid, commercial insurance plans, and other payer types; posts payments in the Electronic Health Record (EHR) system; assists with deposit reconciliation and audits; processes patient refunds; and communicates billing findings and complex account issues to leadership. The role also requires maintaining knowledge of payer guidelines and billing practices, complying with HIPAA, and contributing to a collaborative, service-focused team. The position is primarily performed in a professional office setting using standard office equipment. Travel of less than 25% may be required for training, meetings, or business activities.

Requirements

High school diploma or GED required.
Strong verbal and written communication skills.
Excellent customer service and patient relations skills.
Working knowledge of medical billing workflows, payer requirements, claims processing, and reimbursement practices.
Ability to research and resolve billing, denial, and collection issues effectively.
Strong organizational, critical-thinking, and problem-solving skills.
Proficiency with Electronic Health Records (EHR), practice management systems, and Microsoft Office applications.
Ability to maintain confidentiality and comply with HIPAA regulations.
Ability to perform the essential duties with accuracy, professionalism, and customer service.

Nice To Haves

Two to four years of medical billing, collections, revenue cycle, or related healthcare experience.
Experience working with Medicare, Medicaid, and commercial insurance plans.
Physician practice or specialty healthcare billing experience.
Bilingual skills.

Responsibilities

Monitor claim status and follow up on unpaid, rejected, or denied claims to support timely reimbursement.
Maintain phone availability and make outbound calls to patients, payers, and other stakeholders.
Collect patient balances and accurately post payments in the EHR system.
Research, correct, and process claims for Medicare, Medicaid, commercial insurance plans, and other payer types.
Verify claims and resolve claim edits, denials, and payment discrepancies.
Explain account balances and payment options and respond to patient billing inquiries.
Communicate with providers about incomplete or insufficient documentation needed for claim adjudication.
Assist with daily deposit reconciliation and patient payment balancing.
Gather and prepare documentation for internal and external billing audits.
Process patient refund requests according to established policies and procedures.
Work with billing leadership to resolve complex account and reimbursement issues.
Handle incoming patient billing calls professionally and respond to written correspondence about patient accounts.
Communicate with patients, providers, insurance carriers, and team members by phone, email, and written communication.
Identify denial trends, reimbursement concerns, and recurring patient account issues and communicate findings to leadership.
Research account discrepancies, document findings, and recommend resolution steps.
Maintain current knowledge of payer guidelines, industry regulations, and billing best practices.
Protect patient confidentiality and comply with HIPAA regulations.
Contribute to a positive, collaborative team environment focused on service excellence and departmental goals.
Perform other duties as assigned.