Senior Billing Representative

About the role

Senior Medical Billing Representative Drive Revenue Cycle Excellence. Make a Direct Impact on Patient Care. Are you a seasoned medical billing professional who thrives on solving complex challenges, improving processes, and mentoring others? We're looking for a Senior Medical Billing Representative to join our team and play a key role in maximizing reimbursement, ensuring compliance, and supporting operational excellence across the revenue cycle. In this highly visible role, you'll serve as a subject matter expert in medical billing, denial management, and accounts receivable follow-up while collaborating closely with providers, payors, patients, and internal teams. If you're passionate about revenue cycle performance, continuous improvement, and delivering exceptional results, we'd love to hear from you.

Responsibilities

• Lead Complex Billing Resolution Review, investigate, and resolve complex claim edits, rejections, and billing discrepancies.
• Perform advanced accounts receivable follow-up on unpaid, underpaid, and denied claims.
• Analyze denial trends and implement corrective actions to improve reimbursement outcomes.
• Prepare and submit detailed appeals supported by medical records, documentation, and payor guidelines.
• Ensure claims and appeals meet all timely filing requirements.
• Optimize Revenue Cycle Performance Verify and maintain accurate patient demographics, insurance information, charges, and coding updates.
• Monitor insurance eligibility, benefits, authorization requirements, and referral needs.
• Review medical documentation to ensure compliance with payor medical necessity policies.
• Process authorization requests and track approvals for procedures and services.
• Manage patient and insurance refund requests and monitor self-pay balances.
• Coordinate collection activities and agency placements when appropriate.
• Serve as a Billing Subject Matter Expert Provide guidance and support to team members regarding billing processes, coding, denials, and payor requirements.
• Act as a key resource for resolving escalated billing inquiries and complex account issues.
• Build productive relationships with insurance carriers, physician offices, patients, and internal departments.
• Assist with onboarding and training new team members.
• Drive Continuous Improvement Identify trends impacting reimbursement and recommend process enhancements.
• Stay current on healthcare regulations, billing guidelines, and payor policy changes.
• Commun