Medical Biller

About the role

We are seeking a Medical Biller to join our team and support billing and collections for a busy surgical practice. The ideal candidate will have experience in medical claims follow-up, with a strong understanding of commercial and Medicare insurance plans and out-of-network billing. Prior experience in orthopedic, spine, or pain management services is highly preferred.

Responsibilities

• Maintain up-to-date knowledge of payer policies (including LCDs), billing regulations, and coding guidelines
• Collaborate with clinical and administrative teams to ensure accurate documentation and billing practices
• Maintain organized and detailed records of claim activity, account status, and insurance correspondence
• Review, appeal, and resolve complex claim denials or payment discrepancies, including escalated issues from the AR team, using payer portals and payer communications
• Serve as an escalation point for complex, high-dollar, or unresolved commercial and Medicare claims from the AR team
• Monitor, review, and follow up on outstanding commercial and Medicare claims, providing advanced support and serving as an escalation resource for unresolved, unpaid, or underpaid claims to ensure timely reimbursement
• Excellent communication skills, particularly when working with insurance representatives and internal teams
• Proficient in ICD-10, CPT, and modifier usage

Requirements

• Working knowledge of commercial and Medicare insurance, including plan guidelines
• Experience with out-of-network billing processes; understanding of the IDR process and appeals is a plus
• Ability to review EOBs, denials, and payer communications to ensure timely appeals and maximize revenue capture
• High school diploma or equivalent required
• Medical billing or coding certification is a plus

Qualifications

• Strong problem-solving and organizational skills
• Self-motivated with the ability to work independently and meet deadlines

Benefits

• Competitive compensation based on experience, skills, and growth potential
• Opportunities for professional development and advancement in a specialty billing role
• Supportive, team-oriented work environment
• Hybrid position available after a 90-day probationary period