Medical Biller

4 weeks ago

India Office Beacon ASPL Full time

Experience Level: 3+ years.

Primary Roles & Responsibilities

  • ABA billing experience.
  • TMS (Transcranial Magnetic Stimulation)

1. Claim Preparation and Submission

  • Collect and verify patient and insurance details.
  • Translate physician services into billable codes (often in collaboration with a medical coder).
  • Accurately generate insurance claims using CPT, ICD-10, and HCPCS codes.
  • Submit claims electronically or via paper to insurance payers (Medicare, Medicaid, private insurers).

2. Insurance Verification and Preauthorization (Calling & Online Checking)

  • Confirm patient insurance eligibility and coverage before services are rendered.
  • Obtain prior authorizations when required by insurance providers.

3. Claim Follow-Up

  • Monitor submitted claims for acceptance, rejection, or denial.
  • Identify and correct any denied or rejected claims.
  • Resubmit corrected claims promptly.

4. Payment Posting and Reconciliation

  • Post insurance and patient payments in the billing system.
  • Review EOBs (Explanation of Benefits) and ERAs (Electronic Remittance Advice).
  • Reconcile posted payments with deposits and patient accounts.

5. Patient Billing and Communication

  • Generate and send patient statements electronically for outstanding balances.
  • Communicate with patients (if approved by doctors) regarding billing issues, insurance questions, and payment options.
  • Assist in setting up payment plans if necessary.

6. Compliance and Confidentiality

  • Ensure full compliance with HIPAA and all relevant billing laws.
  • Maintain strict confidentiality of patient and financial data.
  • Stay updated with changing payer guidelines, coding rules, and healthcare regulations.

7. Reporting and Documentation

  • Generate billing and financial reports for physicians or practice managers.
  • Maintain accurate records for internal reviews and external audits.

Skills & Knowledge Required

  • Strong understanding of medical terminology, anatomy, and medical coding systems (ICD-10, CPT, HCPCS).
  • Proficiency with billing software (e.g., Kareo, AdvancedMD, Athenahealth) – varies by client requirements.
  • Familiarity with specific specialties (e.g., Mental Health, Pediatrics, Internal Medicine, Cardiology, Orthopedics, etc.) – client-dependent.
  • Excellent attention to detail and organizational skills.
  • Effective communication and customer service abilities.
  • Solid knowledge of payer-specific rules and federal programs like Medicare / Medicaid / Commercial insurance.

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